Medical billing claim denials can significantly slow down cash flow. That is why it’s extremely important to identify the causes of denied claims and prevent them in the future before they occur.
Denials can be hard and soft. Hard denials cannot be corrected; they have to be written-off. Soft denials can be corrected and the claim resubmitted.
Here are the most common errors that can result in a denial of your medical billing claims.
Incomplete or Incorrect information
Even if a single field is left blank or there is an error in it, the claim can get denied. Most denials are a result of incorrect information, such as incorrect name, gender, DOB and insurance ID. Other incorrect provider information may include address, name, contact information. Incorrect insurance provider information often includes wrong policy numbers or addresses.
When a claim is submitted for a procedure that has already been paid for or reported, it is considered ‘duplicate billing’. Such bills may make it seem that the patient received two identical services on one day, which is wrong.
Not covered by payer
Your medical billing claim may be denied because the procedure is not covered under a patient’s current benefit plan. This can be avoided by checking insurance eligibility details or by calling the insurer before providing services.
Filing time limit exceeded
Most payers need that your medical claims are submitted within a limited time period. Delays can cause claims to be rejected or denied. Reworking denied or rejected claims for incorrect information or inaccurate coding can cause delays. So, it is important that the coding and billing is done accurately the first time. This is why many practices have now moved to outsourcing their medical coding and billing to responsible, professional medical billing companies that specialize in coding and billing.
To make the most of specialty billing, such as pain management billing and coding and behavioral health billing services, call Emerald Health at 855-650-9906 Today!
Healthcare billing involves a large number of people and processes as well as a high level of expertise to make it work well. Not all healthcare providers have the resources to do it efficiently.
Healthcare billing audits can help you understand where you are going wrong and losing money. Billing audits often show the following.
- Missing commitment to follow processes
- Lack of results focus
- Lack of organization
- No genuine teamwork
- Lack of commitment to use resources in billing and revenue cycle
- No commitment to customer service
- Missing revenue
The above listed items make billing complicated. Insurance companies are like constant adversaries to the positive outcome. Audits of medical billing show that missing revenue can range from anywhere between 15% and 50%.
If your in-house billing costs 5% of your revenue but you’re missing 20%, then your billing cost is actually 25% of your revenue. On the other hand, if you outsource your billing process to a professional service at 8% of your revenue and they can recover 100% of your revenue, your billing cost is only 8% of your revenue. Which option is better for your practice?
Billing audits involve running reports and interviewing your key personnel. Assessment of your processes and contracts is important too. A comprehensive detailed audit report would include all aspects of your practice along with findings and recommendations. The insights from these audits can make your practice more efficient and productive.
To learn more, call one of the best medical billing companies in Massachusetts, Emerald Health at 855-650-9906 Today!
Healthcare practices and organizations lose billions of dollars in lost revenue each year in the form of unpaid and underpaid medical claims. You do not get paid for around 5 out of every 100 patients you provide services to. As the amounts add up, it delivers a heavy blow to the financial health of your practice.
Increasing patient responsibilities and the difficulty in collecting payments are becoming a troubling issue for healthcare providers. It is critical for any practice to ensure that you are able to collect what you deserve from your payer contracts.
Here are the 3 most effective tips to avoid underpayment.
Get it Right, the First Time
Accurate coding and proper billing procedures can improve your success rates the first time around, reducing the likelihood of underpayments. Trusted billing and RCM services, such as Emerald Health, ensure ongoing training for billers and coders to ensure the best results for your practice.
Examine Contracts and Renegotiate
An experienced revenue cycle management service can assess your contracts to help you decide whether you need a contract renegotiation. They will help you review everything from fee schedules to patient expense estimations, for each payer.
Recover What’s Owed
Since we know that underpayment is an issue, an RCM service can undertake an underpayment recovery project for you. Such a project would include an analysis of your unpaid and underpaid claims sand identify recovery opportunities. These claims can then be worked upon to recover what’s owed to your practice.
To learn more about how medical billing companies can help you with underpayment recovery, call the medical billing specialist, Emerald Health LLC in Massachusetts at 855-650-9906 Today.
In a medical practice, credit balances occur when improper payments or adjustments are made that exceed the related posted charges. Physicians and practices often face this problem due to the complexity of billing and payment processes.
Credit balances are not really an asset for a practice since they belong to the patient or the state. In fact, they expose the practice to several business and financial risks. This is why credit balances should be addressed with an effective Accounts Receivable (A/R) solution.
Risks with Credits Balances
If you have credit balances on your books for too long, you are burdened with the responsibility of resolving the balance, audits and other costly risks, such as
- billing fraud
- mis-stated profits
- Medicare penalties
- wasted time and processing costs
- lost billing opportunities
- loss of goodwill with patients
Causes of Credit Balances
Most credit balances do not reflect what is actually owed to payers by providers. Credit balances often arise from incorrect posting of allowances, duplicate payments and overpayments by patients and payers, and mis-postings.
Addressing Credit Balances
A good revenue cycle management service can deliver help your practice eliminate credit balances and create a strategy for managing them in the future as well. This can be accomplished with –
- regular account balance audits
- timely refunds to rightful owner
- managing Government and commercial payer timelines
- following up with payers to check if the payment can be offset from future payments depending upon the case
- managing disputes and appeals
To learn more or to take advantage of one of the top medical billing companies and family medicine and specialty billing services, such as neurosurgery medical billing services, call Emerald Health LLC in Massachusetts at 855-650-9906 Today.