3 Most Common Billing Mistakes

Billing mistakes can cost your practice money, frustrate your patients and even put your relationship with insurance providers at risk; however, the vast majority of billing mistakes can be avoided.  Here are three of the most common billing mistakes operations can make and what you can do to avoid them:

1. Simple Data Entry Errors. In many cases, billing mistakes can be chalked up to data entry errors.  Over the years, missed or incorrect keystrokes can cost a practice thousands of dollars.  Data entry errors are also the most difficult type to catch.  Making sure your staff are proficient with office equipment and software will help. One of the best ways to avoid billing errors due to incorrect data entry is to utilize a front end claims scrubber to identify potential key entry errors prior to submission into your practice management system.  In the event scrubbing software is not an option, a audit process of reviewing data entry should be considered.

 

1. Incorrect Coding. Your billing staff should be highly trained professionals with an expertise in coding. With the rapid changes that occur in medicine, medical billing becomes increasingly complex as services are added and removed.  The best solution to solving incorrect coding issues is use of a front end scrubbing software coupled with continuing education for employees.  The “scrubber” would identify potential coding errors prior to submission into your practice management system. Although coding expertise is paramount, many practices have an insufficient training budget.  An investment in the training budget will more than pay for itself through saved revenue.

 

1. Duplicate Billing.  While the billing applications used by medical practices have made great strides in the past decade, the submission of duplicate billings still occur. An example of a duplicate billing error is one service that may have been keyed or coded two separate ways, producing two billings for the same service.  System stability issues and human error are two of the most common reasons for this error.  Scrubbing software could be utilized to identify this error type. If scrubbing software is not available, the best way to avoid duplicate billing is through the audit process. The same audit process that protects you from simple data entry errors can help you identify and flag duplicate billing.

A key part of running a successful practice is educating your staff about potential billing errors.  Continuing to provide your billing staff with as much information and training as possible will surely result in billing mistake reductions.

Should You Outsource Your Medical Billing

This post was originally published by Chris Thorman. He blogs about medical billing programs at Software Advice. You can read the full post here: Should You Outsource Your Medical Billing?

One of the many business questions physicians face is whether to outsource their medical billing to third-party medical billing services or do it in-house with medical billing software. Some physicians want to outsourcing billing to a medical billing service. Others might want to maintain control of collections and do it all in-house.

Both methods of revenue cycle management have benefits and drawbacks. It's up to the individual practice to weigh the pros and cons before deciding which approach is best. We've seen many examples of when a physician group needs to outsource and when they do not. A cost analysis is one of the best things to preform when looking at taking action to outsource your medical billing. While cost is a major factor is not the only one.

Software Advice has broken down in-house billing and outsourced billing in terms of cost and qualitative factors. You'll need to weigh the differences carefully when assessing the needs of your practice and decide if outsourcing makes sense.

You can read the rest of the post here and feel free to contact us for a cost analysis of your practice.

Managing Insurance Carrier Denials in Physician Groups

 Medical claim denials cut right at the jugular of a practice's financial success. The 2009 American Medical Association's (AMA) Heath Insurer Report Card indicated Medicare denials at 4% of all submitted claim lines, with private insurers averaging a 2.8% denial rate.

Sound like small potatoes? Let's look at the numbers: A group practice has 10 physicians, each generating $250,000 in net revenue per year. Accepting a loss of 3% is equivalent to slashing $75,000, assuming all claim line items have an equal value. In reality, higher dollar line items are denied most frequently which further inflates the total loss to the medical group.

 

Today, a medical practice's operating expenses often exceed 50% of its total revenue. With thin margins defining the financial success of a group practice, an aggressive denial management strategy is critical. Adopting such a strategy may sound complex and time consuming, however, a streamlined plan can establish a more efficient billing and collections process resulting in huge dividends.  Here are six easy steps to managing the process in your practice:

 

• Put someone in charge - This will be the responsible party who knows what to look for, where to look for it, and how to address the individual issues while keeping tabs on the big picture.

 

• Standardize the way denials are posted - Denials are often posted in a practice's Practice Management system simply as contractual adjustments, limiting opportunity to trend and correct issues.  Standardized posting procedures offer specific tracking mechanisms and allow generation of meaningful management reports that assist in identifying specifics of denied items.

 

• Create a denied claims log - Logging claim denials provides the ability to track claim numbers, dollar values, dates of resolution and corrective measures. Some practice management system software products can automate this process.  Where automation is not an option, it can be done manually.  Either way, the bottom line is - it should be done.

 

• Track denial reason codes - Are claims denied due to timely filing limitations? Are patients out of network?  Were services considered not medically necessary or non-covered?  Tracking denial reason codes allows a practice to understand the root cause of each denial, providing the opportunity to reduce denial occurrences.

 

• Take corrective measures ("close the loop") - Many claim denials are a result of operational oversights.  Unbundling, inadequate documentation, or even a mismatched age with a procedure code are all denial types that can be remedied by educating staff in coding and billing guidelines.  For example, slight changes to the office registration process could significantly reduce patient eligibility denials. Or perhaps physicians are ordering services without completing the patient's carrier requirements resulting in authorization denials.  In this scenario, physician education and procedural tweaking would decrease future denials and expedite payment.

 

• Embrace efficiency - If automation is available in the practice management system, use it.  Utilizing a paperless environment offers easier tracking and enhanced accountability options while reducing overhead.  Electronic tickler files can serve as an excellent denied claims log.  Also, most clearinghouses offer online access that allows monitoring of claims traffic.  In many cases, carriers provide electronic acknowledgement reports identifying receipt or rejection of claim batches.  In addition, claim scrubbing tools are frequently made available at the clearinghouse or payer level that identify denials and corresponding denial reasons.  Some clearinghouses offer "real time claims adjudication" where minor corrections can be made online (changes to an ICD-9 code or CPT code) for immediate resubmission of the rejected claim.

 

Unaddressed claim denials are as serious as the holes in the hull of a ship. Over time, revenue leakage will sink the entire vessel. By utilizing these easy steps, practices can increase the level of clean claim submissions resulting in elevated collection rates that assist in keeping the practice financially viable for many years to come.

CDHC Consumer - Directed Healthcare - Medical Billing News

ARE YOU READY?

(Part 1 of 2)

The burden of healthcare costs is clearly shifting away from contractual payers resulting in increased patient out of pocket expenses. Under Consumer-Directed Healthcare (CDHC), patients are held to higher deductibles and co-insurance amounts. . According to the Department of Treasury, an increasing number of employers are offering a CDHC plan option for their employees.

http://www.treas.gov/offices/public-affairs/hsa/pdf/fact-sheet-dramatic-growth.pdf 

This growth is already proving evident in increased account receivables in patient responsibility for many practices. Now is the time to consider this impact and address how CDHC is changing the billing and collections best pra ctices used to manage physician practices. Although practices vary by specialty, region, etc., there are some basics to consider as part of every action plan. These include but are not limited to, payer contracts, patient education, time-of-service (TOS) collection processes, and staff education.

Understanding the concept of High Deductible Health Plans (HDHPs) normally offered in conjunction with Health Savings Accounts (HSAs) is critical to the physician practice expecting to maintain strong cash flow and minimize bad dept. Participants in qualified HDHPs are incentivized by lower premiums as well as the ability to participate in tax-free HSAs. Proponents are hopeful this will cause consumers to manage their own healthcare budget dollars. If they are able to control their expenditures throughout the year, HSA funds are allowed to "roll-over," creating a build-up of monies to cover the higher deductibles, out-of-pocket expenses, and future medical costs during retirement. In general, an HSA account is treated much like a 401k with regard to penalties, i.e. withdrawal for non-medical expenses, increasing maximum tax-free contributions, and risk.

Treas.gov is a reliable source of basic information on HDHPs and HSAs as well as the statutory requirements under which they are administered.

http://www.treas.gov/offices/public-affairs/hsa/faq_basics.shtml#hsa2

Ten Steps to a Successful Medical Billing Process

Medical insurance billing can be an overwhelming and complex process, even for those who are involved with it daily.  The effectiveness of the billing process can significantly impact the finances of a practice.  Following these 10 steps can assist a practice in achieving prompt and accurate payment for services.

 Download The 10 Steps Of A
Successful Billing Process