These simple fixes could save thousands of dollars and dozens of headaches. Work them into your billing processes!
Is your treatment center experiencing financial difficulties? There are many billing errors that can cause claims to be denied. Payments being delayed, incurring fines, and revenue loss can all happen due to errors not being caught before submitting claims. So before you start sending your claims out, beware or the most common mistakes.
1. Having a brain lapse and forgetting to verify insurance
Believe it or not, the top reason why most claims are denied is because there was no initial verification of benefits and coverage. We all know insurance can change for whatever reason. So it is crucial that the provider verifies it every time services are rendered. When you don’t verify insurance properly, things like are overlooked like.
- Members coverage may be terminated
- The service isn’t even authorized in the first place
- The plan benefit doesn’t cover the service being rendered
- The Lifetime Maximum benefit has been met
2. Inaccuracies in the Patient’s File
You would be surprised how something as simple as a patient’s name being misspelled, or having the wrong date of birth, or is this the patient relationship status to the insured correct, also using a policy number that is invalid can cause claims to be denied upfront. However there are some pieces of information that aren’t so clear and easy to notice like.
- The claim requiring a group number to be entered
- Making sure the diagnosis code matches with the procedure code
- If there are multiple insurances, making sure the primary insurance is right for coordination of benefits
You don’t want to have to miss one of these simple pieces of information — making the claim go from say a 1-2 week turnaround, to a 30 to 45 days before the claim is paid.
3. Not using the Correct Diagnosis or Revenue/HCPC Codes on Claim
Like stated above making sure the diagnosis and procedure codes match are very important, but more importantly you want to be sure the codes being used are actually correct. This is how the insurance company knows the symptoms, disorders and how they are being treated by the facility. Incorrect information can result in a immediate denial of the claim for not being medically necessary, or it doesn’t match the authorization given for treatment.
Couple of things to consider as to why the wrong diagnosis or procedure code could be submitted resulting in denial.
- Your Coding books are out of date and you’re using old protocols that have been revised. They can be pricey but is it really worth losing revenue on avoidable denial errors?
- You might laugh, but if you handwriting is not up to par and causing claims to be denied because of horrible penmanship, you should really consider switching from paper claims to a electronic submission.
4. Duplicate Billing
Duplicate billing is just what it sounds like, billing for the same service or treatment on more than one claim. It can also be considered as billing for a procedure that wasn’t even performed in the first place. It is very key to perform Chart audits for all patient’s to ensure claims are being billed out correctly. Ultimately you want to try and limit this to none, as facilities are fined each year for these small mistakes and considered as committing fraud. Ouch!
5. Misrepresenting Level of Care
This occurs when you the level of care is incorrect in order to receive a higher reimbursement rate from the insurer, also referred to as up-coding. Claims are looked at in fine detail to it’s better to just not do, or once again it will deny and stall the claim payment.