Billing mistakes can lead to denials, appeals, delayed payments, and even legal issues.
Therefore, your organization needs to identify billing mistakes and learn how to keep them from happening. Training and policies are imperative to keeping errors at a minimum.
“It starts at registration!” is a phrase I learned during my billing training. It rings true, as this is where the billing starts. Examples of billing errors are incorrect dates of birth, incorrect spelling of names, and incorrect insurance information. Medicare is particular with the patient’s address. Claims have been denied if the address on the medical claim did not match their system. Although it is easy to fix the error, it will delay payment on the account.
Insurance and benefits verification is another top denial with insurance companies. It is good practice to get insurance information before services are rendered. Is the insurance active? Is the patient’s name the same as listed on the card? Are the services covered? Are there any exclusions or limitations that may affect coverage? Do they have a copay or a deductible? What are their out-of-pocket limits and the percentage of their co-insurance? Is a referral or preauthorization required?
The best way to keep these errors minimal is to create a policy.
First, create a template with questions to ask when calling on benefits and eligibility that are important for your practice to know. Then, your new hires can work more independently.
Get familiar with the insurance cards that are presented in your office.
For example, Medica has several different group numbers. These group numbers indicate which payor ID the claims need to go to. You can also look at the symbols on the card to know which insurances you are in-network or out-of-network.
These are just a few suggestions to help you on your road to fewer denials and more payments. In addition, policies and training will increase your chance of clean claims and decrease insurance denials and appeals. Prevention starts at the front desk.