How to Achieve Optimum Billing Performance

May 15, 2021

Billing can be a very complicated process, but it’s one that is vital to the success of your practice. There are a number of potential problems that can result in claim denials, which will, in turn, hurt your ability to maximize your collections.

The following are some of the common billing issues that practices run into and how they can be resolved in order to achieve optimum billing performance:

The claim is for uncovered services – You won’t be able to collect on the claim if it’s for a service that’s not covered by insurance or if the insurance of the patient has been terminated. To avoid such problems, you should always make sure that patients are fully insured and covered before you provide them with medical services.

The claim is missing information – Any time a claim is missing certain information, it can be denied. This includes information such as the date of the accident, the date of the medical emergency and more. The person filing the claim in your office has to be diligent about writing it to avoid such simple errors or it could end up costing you.

The claim isn’t filed on time – In accordance with the Affordable Care Act, you have to submit a claim within 12 months of the time that you provided the service. It must be received by the end of the 12-month period – not sent out by that date. If the claim isn’t received on time, it may be denied. To ensure that this doesn’t happen, you have to make sure that your billing process is streamlined and organized.

The claim used incorrect patient identifier information – This could be as simple of a mistake as misspelling the patient’s name. For every claim you submit, you need to make sure that all of the patient’s information is correct, including their name, their date of birth, their insurance payer and their policy number.

The claim isn’t specific enough – Every claim that your practice submits must contain a diagnosis that is coded to the highest level for that code. For example, the code for diabetes is four digits, but a fifth digit is required to specify the type of diabetes. If you only include the four digit code, your claim is likely to be denied.

The claim uses the wrong code – If the wrong code is used, then the claim can be denied. Make sure that you not only use the right codes, but that your coding book is up to date. Otherwise, you’ll have to appeal the denial, which requires more resources and will make the process of getting paid take even longer.

The claim doesn’t properly support medical necessity – In some cases, a payer won’t adjudicate a claim unless you provide certain medical records proving that the service you provided was necessary to the patient’s health. In such a case, you may need to provide the physical reports, medical history, discharge summaries, consultation reports and more.

To avoid being unable to meet these requirements, always keep documentation that supports the necessity of the service you’ve provided. These are some of the most common billingrelated issues that can hurt your ability to maximize your collections.

ProMD Practice Management is happy to help with your billing assessment needs so you can maximize profits and increase patient satisfaction. To learn more about how ProMD can make your practice run like a well-oiled machine, call 888-622-7498 or fill out our online form to request a billing assessment.

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