Submission of error-free claims and securing accurate insurance reimbursements is the most challenging and crucial task for any practice owner. Sloppy billing and coding practices make things worse. According to CMS (Centers for Medicare & Medicaid Services), Medicare improperly paid $6.25 billion in fee-for-service claims. Fortunately, practicing physicians and administrators can take steps to ensure they get paid in a timely manner. This requires forethought, training, and commitment on the part of all practitioners. Many practice owners handle all medical coding and billing on their own by claiming they didn’t attend medical school to become coders and billers. Even so, medical coding is an essential component of revenue cycle management, and a practice that doesn’t do it well can face severe financial consequences, whether it’s frequent claims denials or over billing. As a practice owner, we should avoid the following 7 billing and coding mistakes for the year 2022.
Expenses not covered by a patient’s insurance
The most common coding error done by practices is claiming an expense that is not covered by the patient’s insurance. Practices should verify a patient’s eligibility and coverage during every visit. Verifying insurance eligibility and coverage for the planned procedure helps determine insurance coverage. It enables you to calculate the number of covered visits, unpaid deductibles, and co-payments so you can share precise cost estimations with patients.
Expired insurance coverage
When an insurance plan has expired, you can use a benefits report to estimate costs confidently. A patient who receives covered medical services only pays the co-payment amount at the time of service. Non-covered services are really difficult to recover from the patient. With each passing day that passes after the patient leaves the office, the possibility of collecting patient payments fades away.
Lack of coordination of patient benefits
Patients who have multiple health insurance plans may not be able to receive their medical claim benefits due to a lack of coordination of benefits. COB, or coordination of benefits, means determining whether a health insurance company is a primary or secondary payer. The majority of practices do not ask for secondary insurance information. COB greatly simplifies the process of determining the primary payer’s responsibilities and also determining the secondary payer’s contribution.
Lack of required precertification/authorization for an expense
Expenses without necessary pre-authorization or pre-certification: Any claim that is denied due to lack of pre-authorization or pre-certification is considered a hard denial, and the insurance carrier may not reverse its decision. More and more patients are choosing High Deductible Health Plans (HDHP), leading to a significant increase in prior authorization requests. Depending on your medical specialty, you might need a list of procedure codes that require prior authorization. When a claim is denied because of the lack of prior authorization, it is really hard to get it reversed.
No Specific Clinical Notes
Providers can minimize claim denials by writing concise, specific, and detailed notes. An insufficiently specific diagnosis is one of the most common reasons for denials. When you provide clinical details like the severity of the issue and whether it is chronic or acute, you will find the most specific diagnosis code and your claim will be paid faster.
Non-Documenting Time-Based Services
Non-Documenting Time-Based Services: When reporting E/M services codes, documentation is essential. In most cases, providers will use the same bunch of procedure codes repeatedly for a wide range of procedures. This can lead to a coding audit.
Other Mistakes
Apart from the above mistakes, there are many more such as not signing the notes, having the billing provider and service provider names mismatched, having the CPT codes for the service incompatible with the place of service, having the patient’s benefits reached, having duplicate claims, having procedure and modification combinations that are incompatible, and not having referrals listed.
Any practice owner, especially those in small groups or solo practice, would do well to stay informed of billing guidelines and reimbursement policies. Audits will always occur, so don’t assume everything is fine just because you’re getting paid. If you are a practice owner and don’t have the time to perfect your revenue cycle management activities, we can help. With offices in Texas and Wyoming, Apex MedPro provides complete revenue cycle solutions. With our billing services, you will receive accurate insurance reimbursements from private and government payers. For more information about our medical specialty wise billing and coding services, please contact us at info@apexmedpro.com or call us at 877-333-1760 for immediate assistance.