Due to the consistent changes in the federal rules & regulations and payer’s policies, the physician billing services are getting complicated on a daily basis. The cacophony of codes can pose a host of challenges for even the most well-organized billing departments. Adding to the matrix of grunt work carried out by unstrained staff in filing claims, inadvertent errors are almost the most occurring risks that can lead to loss of time and money in unimaginable proportions. Unfortunately, the smallest errors in physician billing services can cause claim denials and result in a significant revenue loss.
In addition to this, frequent errors can negatively influence the relationship with patients. Therefore, physicians need to adopt strategies in order to avoid physician billing errors. In this article, I have provided a quick guideline about the top 10 tips to prevent loopholes and errors in physician billing services and how your physician revenue cycle management can harmonize with compliance.
- Acquire The Medical History of Patients:
Providers can prevent a large chunk of errors in their physician billing services by verifying the benefits at the source where the patient avails a service. If a patient regularly visits a physician then it can be hard to resist using his recently entered information.
However, if a certain change occurs in the patient’s insurance provider, the policy limit, or the terms of services, then it can cause errors in the medical billing. Whether the patient is newly registered or a regular, independently verify and communicate details such as authorization, healthcare benefits, co-payment options as well as the coverage term with the insurance company. All of this information is crucial to include in the medical claims in order to get reimbursements.
- Verify Accuracy in Patient Information:
If there are trivial errors in the information of the patient’s name, gender and his/her date of birth can be grounds for claims rejections. It is crucial to have mismatched data which includes policy and group number of the patient who is dependent on the primary insurance holder.
- Double-check the data:
Medical billers should make to harmonize with the compliance and adopt correct procedural and diagnostic codes. It is essential to use accurate medical codes in order to get reimbursements from the insurance payers. Practitioners must pay attention that if they have an in-house department for physician billing services then they should provide consistent training to them. If they find it daunting to arrange training sessions then they should outsource to a reliable medical company that has all the set up to train medical billing staff. It is paramount for providers to search for the latest medical coding guidelines from the “codebook” for reference to prevent committing expensive coding errors.
- Use Electronic Health Records:
When a medical provider writes a prescription in an incomprehensible way then it can result in claim denials. Therefore, medical billing staff is highly responsible for preparing easy to understand claims that don’t include complicated jargon of medical codes in the medical claims. Alternatively, they can use automated software solutions for innovative billing services such as Electronic Health Records.
- Make Sure That Same Bill Is Not Used For Twice:
Practitioners must perform medical audits to get free from the hassles in the future related to double billing. This is one of the most common errors in the medical billing process. Because furnishing bills for canceled or rescheduled procedures can increase the chance of claim rejections. Therefore, providers should carry out regular medical audits and keep the track records of claim history in the charts to prevent errors from proliferating.
- Include Complete Information:
If you haven’t mentioned the complete information in the medical claim then expect nothing else than a denial or delay of reimbursements. For example, omitting the inclusion of fourth and fifth digit, or not linking diagnosis code to Health Healthcare Common Procedure Coding System (HCPCS) code or Current Procedural Terminology (CPT) can impact the credibility of a medical claim negatively. In most cases, such errors occur due to human mistakes. But they can also occur due to incorrect diagnosis information provided by the front desk staff.
- Prevent Upcoding:
Upcoding can happen deliberately, but insurers just translate it as the abusive medical billing practice. It is a practice where the comprehensive procedures are reported which is different from the actual minimalistic procedure carried out by the doctor. As a result, it also gives rise to compliance issues because the payers won’t reimburse providers at a higher rate. Therefore, it is the best practice to furnish correct codes to prevail in the authenticity and credibility of your medical practices.
- Medical Coders Should Consider Bilateral Services:
Bilateral services and procedures such as X-rays, vaccinations, medications etc. must be explicitly highlighted so that the coders become aware that it is inclusive of the healthcare service. When coders work at a different location from the provider, the biller will not be aware of the bilateral services if the doctor forgets to mention.
- Use Medical Codes At The Highest Level Of Specificity:
It is a primary responsibility of a medical coder to take precaution and endure that they use medical codes at the highest level of specificity. Due to the implementation of the ICD-10 coding scheme, medical coders should use the last two digits with high accuracy to avoid errors in medical claims. Whenever medical coders encounter challenges while translating medical procedures into standard codes then they should refer to the “codebook”.
- Comply With The Latest Medical Coding Guidelines:
Medical coders should consider that outdated reference manual can significantly impact the physician revenue cycle management. They should keep the knowledge of current coding guidelines and federal policies that are related to medical billing procedures. The latest information can aid in a seamless physician billing process of healthcare claims without delay or revenue loss.
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Photo courtesy of: KYR News
Originally Published On: KYR News
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