Use These Practical Strategies for Keeping Claims from Coming Back Unpaid
Remember the kids’ song, “The Cat Came Back?”
In the song, old Mr. Johnson tried everything to get an unwanted feline out of his home (including, in some decidedly kid-unfriendly versions, tactics that would provoke The Humane Society’s wrath). But, as the refrain repeatedly tells us, “the cat came back the very next day.”
At MDCodePro, we see many healthcare organizations struggling with common medical billing issues, and we can’t help but think of Mr. Johnson’s cat.
Providers submit claims to payers and think they’ve seen the last of them. But soon enough (though not the very next day), the claims come back, rejected or denied, to cause chaos counted in lost time, lost energy, and lost income.
Challenged revenue in today’s healthcare sector amounts to between $11 billion and $54 billion a year. Hospitals and health systems see up to 3.3% of net patient revenue, or $4.9 million per hospital, jeopardized by denials. Even private practices with industry average denial rates of 5-10% can see huge shortfalls due to returned claims, as in a scenario professional coder Yvonne Dailey presented at one conference in which a practice’s $945 daily loss through denials totaled $226,800 by year’s end.
That’s entirely too many “cats coming back!”
While some rejections and denials are inevitable, many are preventable. Investing extra time, effort, and (in some cases) expense to avoid the most frequently found medical billing mistakes before you ever submit your claims can ultimately pay off in greater profitability.
So what can your organization do to correct medical billing errors and get claims successfully out the door so only revenue comes back?
Five Ways to Fix Your Billing Problems Before They Begin
Here are a few tips for taking care of medical billing issues commonly responsible for rejections and denials.
- Double-Check All Patient and Provider Information
We know; it sounds too simple. But errors as minor as a misspelled name, an out-of-date address, or transposed digits in an insurance ID number can and do get claims rejected and returned. The AAFP recommends strengthening front-end staff’s data entry skills and implementing technological safety nets for catching mistakes as soon as they happen (for instance, alerting users when they enter too many or too few digits in a given field).
- Verify Patient Eligibility
A denied claim shouldn’t be your first sign a patient wasn’t eligible for the services you provided. People’s insurance statuses can change quickly, so ask patients about their plans when scheduling appointments and at every visit. Insurers’ website portals, clearinghouses, and some practice management systems will help you verify what services a patient’s insurer will cover, and whether patients have maxed out their benefits. Keep all verification information should you need to prove patients’ eligibility later.
- Provide Only Authorized Services
Like it or not, you’ve got to treat patients by their insurers’ rules if you want to get paid. That means ensuring patients obtain a referral (if you’re a specialist) and providing only those services you’ve received prior authorization to provide. As a 2017 AMA survey shows, the prior authorization process is slow and burdensome, but until reform happens (and some positive changes may be stirring), ignoring it will only cost you time and money.
- Avoid Duplicate Billing
It’s often hard enough to get insurers to authorize a service once. They’re not eager to pay for the same service twice. Granted, many “duplicate” bills result from simple human error—for example, no one removed a canceled procedure from a patient’s account. But payers are vigilant to the threat of fraud, and duplicate bills raise big red flags. Establishing and sticking with an internal audit system can cut down on your risk of submitting duplicate claims.
- File Claims On Time
Most private insurers don’t share Medicare’s year-long window for filing claims. Time limits of 30, 60, or 90 days are more typical. Failing to file claims on time is a surefire way to see them come back denied. And once deadlines have passed, you can’t appeal or bill the patient. Make sure your billing staff knows how quickly the insurers with whom you regularly work expect to see claims while generating and saving electronic proof of timely filings.
Fix Number Six: Equip Practitioners to Avoid Medical Coding Errors
Whether they’re too high (overcoded), too low (undercoded), mistakenly applied (as modifiers often are), or missing altogether, diagnosis and procedure codes often get claims returned unpaid. Incorrect coding is one of the most commonly cited medical billing issues keeping providers from getting paid the first time around.
Ensuring quality coding isn’t just a job for your staff’s professional coders or a third-party coding and billing service. Quality coding only happens when physicians and other practitioners provide quality documentation. The more your clinicians know about how to document a patient visit accurately and code it correctly, the more clean claims you’ll submit, and the faster you get paid.
Why not find out for yourself? The MDCodePro app is the proven way to translate practitioners’ improved documentation and coding into more revenue. Hundreds of doctors who’ve learned and started using the multiple audit-validated MDCodePro approach have seen their annual incomes increase by $30,000 on average.
Sign up for your MDCode subscription today, and see what a difference it makes in helping you avoid the consequences of inaccurate coding and incorrect billing by steering clear of those inaccuracies to start with. You’ll have far fewer claims come back… except in the form of payment!