These days, in the healthcare industry, one of the most essential activities revolves around medical billing and coding. It is integral to the reimbursement cycle because the way every claim is coded and submitted for insurance reimbursement determines how quickly or slowly it is paid, or even if it isn’t paid at all. This results in a great deal of frustration for medical providers, billing professionals and American businesses.
In order to correct the procedure so that it can be more efficient and so that patients can be reimbursed in a timely manner, it’s important to know about the five most common and costly billing errors that occur and how to prevent them.
Know the Details of Each Insurance Policy
Every insurance policy has its own set of criteria for billing various items for reimbursement. For example, if a patient needs a specific corrective medical device, you must know the guidelines for properly claiming it. Submitting an incorrect claim can slow down the payment or even run the risk of no reimbursement being made at all. This results in the need to resubmit the claim after a cycle of rejection.
To ensure that the chief points in claims are met, the claim is fresh and paid upon the first submission and to avoid appeals that can be expensive, you must do the following:
- Thoroughly research each policy prior to making a claim. Every policy is unique, so this is crucial.
- Select a member of your team to research any policy changes. One person can handle this task for around four to six hours per week. Medicare even offers free webinars to educate staff on the claims process.
- Maintain weekly research and keep up with policy changes.
If you rely on third-party billing providers, it’s important to know that members also serve as Medicare liaisons and keep up with any changes as they arise.
Assign the Proper Billing Code Modifier
Insurance companies designate a specific billing code for each medical procedure, medical service or corrective medical device. Additionally, a two-digit modifier is needed as well to represent one side of the body, such as LT for “left” and RT for “right.” Billing codes and modifiers need to be implemented into the software you use for medical billing to make the claims process smoother.
You can prevent errors in this area by thoroughly researching all billing codes and modifiers. All claims should include both.
Understand Prescription Guidelines
You must always know the proper guidelines for prescription submissions. Each one should include a start date, doctor’s signature, end date, items delivered (not generic) and what has been expensed to the patient and billed to Medicare.
Preventing this error is fairly easy and merely requires details of what is being prescribed and why.
Update Employee Address Records
Many claims are rejected simply because of incorrect address information for a patient. It is essential that Medicare has all patients’ current home addresses on file.
To prevent this mistake, it’s important to call Medicare’s automated system to check whether a patient’s active residence is on file. Always verify patients’ insurance information before they come to the office for an appointment and be aware that a patient’s resident can change at any time.
Know Patient ID Numbers
Many claims are rejected because there is an incorrect patient ID number in place. You must verify that all IDs are correct.
Preventing this error requires checking the insurance policy to ensure the correct ID is used. It can then be verified for use with the claim.
Using all of these tips will ensure that your medical billing system is much more efficient. Less time will be wasted and claims will be paid faster.