Billing is very complex process, but is also very crucial for successful practice. There are common errors which result in claim denials, which affects directly to collections.
There are very common billing errors that practices commit often:
1. Uncovered Services Claim:
Always confirm that patient is fully insured and covered before you provide him medical services. There is no reimbursement on the claim if the service is not covered by insurance or if the insurance of patient has been terminated.
2. Incomplete or Missing Information in Claim:
If claim submitted is missing information, or having incomplete information, like date of accident or date of the medical emergency, it is denied. The staff filing the claim in your office should be diligent about to avoid such simple errors otherwise it could end up monetary loss.
3. Claim Not Filed On Time:
As per the Affordable Care Act, one has to submit a claim within 12 months from the date of service provided. If claim not received on time, it is denied. Make sure that billing process is streamlined and organized.
4. Incorrect Patient Identifier Information:
For each and every claim submitted, make sure that all of patient’s information is correct, such as their name, their date of birth, their insurance payer and their policy number.
5. Unspecific Claim:
Each and every claim submitted must contain a perfect diagnosis code. For example, the code for certain disease is four digits, but a fifth digit is required to specify the type of such disease. If only four digit code is submitted, claim may be denied.
6. Claim With Wrong Code:
Claim is denied, if wrong code is used. Be certain that to use the right codes, and ensure that your coding book is up to date. Otherwise, you have to appeal against denial, which consume more resources and the process of getting paid take longer.
7. Claim Not Supporting Medical Necessity:
Claim will be denied, if the medical records provided by your office does not support medical necessity. Always provide physical reports, medical history, discharge summaries, consultation reports and other supporting documents.
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