A minor write-off in medical billing and coding can end up in the denial of payment. If a payment is denied, profits of a physician practice can go down with a tiring process of sending revised claims and following it. There can be a number of reasons due to which you can face a payment denial. I am listing down just top 5 of them:
Important data such as patient demographics, name, age, contact details, social insurance number etc. is the easiest part of medical billing, however, your front office staff can leave it incomplete due to many reasons. In most of the cases, such type of inadequacy in the vital billing information can lead to denial of payments.
Avoidance: This type of error in medical billing can be resolved by training your front office on how to take all the patient related information and checking it twice after collecting.
Inappropriate Coding and Modifiers:
Inappropriate coding: The claim of payment can be rejected if there is improper coding or wrong modifiers have been used. As, for getting the highest proximity level and for specifying a variation in a medical condition, the medical billing and coding staff should be properly trained to use the right codes with accurate modifiers.
Upcoding refers to the coding of a diagnosis in an incorrect manner or provider bills a health insurance payer using a CPT code for a more expensive service that was performed. It can also happen due to inappropriate information forwarded by the provider to the billing staff. Due to this reason, patients are compelled to pay more than what they have received during the course of a medical treatment.
Avoidance: To ensure accuracy in your billing and coding, take the services of only certified medical coding and billing professionals. Use the right codes and double-check their accuracy before submission.
Verification of Insurance:
Unverified insurance can be one of the leading reasons of the unacceptability of medical billings that leads to the loss of payment and thus loss of revenue. So, to verify insurance, you and your staff should be careful and dedicated enough to both existing and new patients.
Avoidance:To keep a record of effective dates and an entire period of treatment, analyze the amount paid by the policyholder and copayments and keep track of exclusion of the conditions that are existing already. Errors should be ignored if most of the benefits and needs of the patients are fulfilled.
Errors during medical charting and coding:
Sometimes, during medical billing, man-made errors can happen due to carelessness or lack of experience in the relevant field. These types of errors can cause a denial of medical billing as well. Such errors can be:
- Misinterpreting a medical diagnosis
- Inadequacy of the required information of the patient
- Missing information about all the procedures performed through the course of a medical treatment
Avoidance:Reduce human errors by optimizing the medical charting and coding system. Optimization can be done by implementing a suitable and effective Practice Management System.
Over reporting refers to a report in an exaggerated manner. It can include the segmentation of a single medical procedure (that can be inclusive of more than one step) and then charging for each segment. This exaggeration is invalid and can cause payment denials.
Avoidance:This problem can be eradicated by formulating a unified method that brings the team into a systematic billing flow.
Negligible medical billing and coding errors can result in payment denials when their avoidance is just as easy as to consult a professional medical billing company.