It’s easy to make small mistakes when billing. Unfortunately, small mistakes can sometimes cost you big money. Fortunately, it might not be as difficult as you think to avoid them. Here are five ways to prevent some of the most common — and costly — billing mistakes.
Use the right modifiers
By now, everyone is accustomed to ICD-10. Or mostly accustomed. But modifiers can still be tricky. Not using modifiers can, of course, cause a claim to be denied. But so can using the wrong one.
Not using the right modifier is one of the most common billing errors, says Karen Lake, healthcare consultant with Pearce, Bevill, Leesburg, Moore.
Making sure your staff is well-trained is key to avoiding this mistake. Don't waste time training and retraining staff on codes that you're practice doesn't use. Instead, be sure training focuses on any diagnoses and procedures your practice uses often.
Bill the right payer
This may sound like a no-brainer, but it’s actually an easy mistake to make. Lake offers a good example of how this can happen. Say a patient comes in and gives you his Medicare card. The front desk carefully records the information, and billing submits the charge to Medicare. But the claim is rejected, maybe even from the clearinghouse.
The problem? The patient thinks he’s on Medicare, but his policy is actually with Blue Cross, United Health Care or another Medicare Advantage plan. The easiest way to avoid this kind of mistake is to always verify insurance at check-in.
Sweat the small stuff
Leaving off even one of the required fields in a bill can result in a denial. It’s easy to double-check to make sure you've provided all the required information before submitting the claim. What’s trickier is making sure all the data in those fields is correct. It’s easy to misspell a name or transpose numbers, especially during busy times at the front desk.
Despite the hectic pace, it’s worth taking the time to slow down and get this right. Then taking a little more time to double check. Kenneth Hertz, FACMPE, principle consultant at MGMA Health Care Consulting Group, suggests having a separate space for taking insurance information, if possible. A separate room is ideal, but if you don't have the space for that, at least try to arrange for a cubicle or quiet corner to keep distractions to a minimum during this detail-oriented process.
Run an analysis
If you’re really serious about reducing billing errors, it’s worth the time to analyze your mistakes. EHR systems allow you to customize reports, says Brennan Cantrell, commercial health insurance strategist for the AAFP. "I like to look at high-dollar claims first," he says, to get the most return on his investment of time.
Whatever approach you take, make sure you look for any patterns in your mistakes. Are you making a lot of coding errors? Are those coming from billing or from clinical? Spotting your most frequent mistakes can help you set your training priorities.
Explain your decisions
Not getting prior authorizations when payers require them for procedures and medications is another common mistake. They’re also a hassle. “Pre-authorizations are a big administrative burden. It’s one of the biggest issues for our members,” Cantrell says. “If you have enough staff, it’s ideal have one person in charge of this.” If that’s not possible, you may need to consider reviewing and adjusting workloads.
You also need to make sure the diagnosis code and the procedure code match in order to demonstrate medical necessity to payers. If not, the claim will be refused. It’s important that your staff be well trained on coding if you want to avoid this common error. This applies to clinical staff as well as billing staff. "It’s a good idea if the billing department does in-service training so that the clinical staff has a better idea of how to code complicated cases," Lake advises. "They don’t need to know all the details, but they do need to know when to call in the billing department for clarification."
Mistakes happen. But if you learn from those mistakes, you can avoid making them in the future — and save money while improving your practice.