Mistakes in billing for patient fees can be costly for your independent practice, in many ways. Constantly having to correct those errors wastes your staff’s time and, of course, billing incorrectly costs you financially. Planning, training, using technology properly, and paying closer attention to the details can help you and your staff tremendously as you work toward reducing billing and collection errors.
The proper technology, including your electronic health record (EHR) solution, can help you and your team reduce or eliminate the occurrence of unnecessary or duplicate tests and procedures. EHRs keep all of your patients’ information in one place, helping to ensure consistency and quality of care as well as reducing the potential for billing and collection errors.
EHRs also benefit your practice by:
- Reducing the time and resources needed for manual charge entry, which results in more accurate billing and reduction in lost charges
- Reducing charge lag days and vendor/insurance denials associated with late filing
- Providing you with charge review edits that alert you as to whether a test can be performed only at a certain frequency
- Alerting you that you will need to obtain Advance Beneficiary Notice, minimizing claim denials and lost charges related to Medicare procedures performed without Advance Beneficiary Notice.
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Specific strategies that you can use to help your practice in reducing billing and collecting errors include:
Ensure that all patient data is accurate. Your claim can be denied when you don’t identify the patient properly. It’s important to be sure that policy numbers are accurate, and names are spelled correctly.
Take advantage of technology to proactively flag claims that payers are likely to deny. You can then fix the potential issues before you submit the claims.
Conduct regular staff training. Coding updates and billing changes happen frequently. Keep your staff up to date and informed about these changes on a regular basis.
Stay on top of trends. Assign someone on your team to stay informed about top denials that occur for small and independent practices each week.
Some of those common coding and billing errors can include:
- Using incorrect modifiers. Not using a modifier or using the wrong one can cause a claim to be denied. Ensure that your staff is current on the codes for diagnoses and procedures that your practice uses most often.
- Not billing the right payer. Verify the patient’s coverage at check-in each time, with both primary and secondary insurances. For example, a patient may believe that he is on Medicare, but his policy may be with a Medicare Advantage plan and so will need to billed differently.
- Missing a detail on the claim. When you leave data out of a claim, it can result in a denial. Be sure you have provided all the required information before submitting the claim. Also, make sure all the data is correct. Transposing numbers or misspelling a name can result in a denial.
- Not getting prior authorizations when necessary. Many payers require prior authorizations for procedures and medications. Make sure the diagnosis code and the procedure code match to demonstrate medical necessity.
Use your EHR system to run an analysis for help in reducing billing and collecting errors for your independent practice. Look for patterns in the denials. Prepare your staff training based on the results. Analyzing and correcting those errors can help you significantly reduce your denial rate and increase your practice revenue.