Why Your Claims Might Be Bouncing Back
Sybrid News | Jun 01, 2018
Billing can get quite complicated and hectic. This holds true specifically for ICD-10 codes. While you might think that your claims are bouncing because of some technical mumbo-jumbo, the reasons are usually basic. To make sure your claims are not returned, you must be well-versed on the common reasons of returned claims and how you can best avoid them.
Here are some of the basic reasons you should know about:
Typos Ruin It All
One of the biggest reason for claims bouncing back is typos. The concerned error might be very small. This is what makes typos so dangerous. It is easy to miss them when you are cross checking your documents.
One of the biggest sources of typos is the front office. It is common for the personnel to transpose some of the policy numbers or omit an important letter or number. You can’t really blame the personnel either. After all, they are swamped with work and such mistakes are hard to detect.
The best way to avoid this issue is to hire an employee whose job would be to merely recheck and correct if any errors are spotted. If your practice isn’t big, you don’t necessarily have to invest in a full-time employee. You can just hire someone part-time for it.
You Forgot Crucial Information!
Your claims might bounce if you fail to deliver all the required information. Any claim with incomplete information is not processed any further. This is why it is important to recheck if you have submitted all the required documents. Remember, claims require a lot of supporting material. It is best if you re-read the requirements to ensure you don’t miss any valuable information.
You Didn’t Get Prior Authorization
In some claims, you might need to get prior authorization. If you don’t get this and proceed to conduct all the other procedures, you are doing it all in vain. Your claim will not be forwarded unless the prior authorization is gained. Know whether such is needed before you schedule the procedure and ensure the authorization number is added to the claim when you bill it.
You Didn’t See It Again
Let’s say an old patient comes in. You know their coverage because of last time. Now, you would be tempted to carry forward their claim without looking at their plan again. This is a mistake that can lead to claims being bounced back. Why? Well, often, a coverage plan may be canceled or changed. Your patient might not tell you about it for obvious reasons and once you have given them your services, you will find that their insurance doesn’t quite cover the expenses. Rather than being blindsided, it is best you check the insurance card and plan of the patient before filing the claim.
Know the Policies
Insurance policies are not stagnant. Just because a given policy covered something once doesn’t mean it will always cover it. This is why it is important to keep up with the recent changes in different policies. If you don’t, you might think that a given plan covers something that it no longer does, leading to your claim to be rejected. How do you learn about these changes? Simple. You keep up with the policy announcements of the payers. Depending on the size of your practice, you can allocate people to do this. In big practices, the responsibility of keeping tabs on policy changes may fall on the shoulders of the administrators. In small practices, a billing staff may have to do it. The fact of the matter is that someone has to do it.