When denied claim demons send shivers up your spine, when ghosts of appeals past chill your bones, when ERAs haunt your sleep, you might be a healthcare biller.
A biller’s job can be downright scary. Rejected claims, incorrect coding and eligibility errors are the stuff of nightmares for a billing team. So what are the things that keep a healthcare biller up at night?
Here are the top-10 things that scare billers everywhere:
10. Forgetting to work denied and rejected claims
Denials and rejections will always prevent you from getting reimbursements in a timely manner. Claims are rejected because of errors. Claims that a payer determines to be unpayable are denied. Rejected claims can be resubmitted after you address the errors. Denied claims can be appealed and reprocessed but only in some cases.
9. Not verifying eligibility or insurance benefits
Before treating a patient, you must make sure Medicare or the insurance company will cover the treatment so you’re not stuck with a denied claim. Check coverage dates, allowed benefits, co-payments and authorizations for each patient because not doing so will adversely affect your reimbursement.
8. Not billing claims in a timely manner
All claims must be sent as soon as possible, so everyone receives the reimbursement they are due. If a claim falls through the cracks, it may be too late. A healthcare biller must file Medicare claims no later than 12 months after the date when the services were provided.
7. Not using CPT codes & modifiers correctly
These tools provide additional information about a procedure, and sometimes you need them when coding. Keep in mind, there are rules for using modifiers and using them inappropriately will likely lead to claim denials. Make sure you have the latest “cheat sheets” for CPTs and modifiers.
6. Duplicate billing
This can cause big problems. Sometimes, a provider might charge for a procedure that was cancelled or rescheduled. Or a doctor and nurse both request a charge for a service. Billing teams should have a system in place to prevent this. Chart audits can help track submitted claims.
5. Coding errors
Accurate coding is critical to a healthcare facility’s bottom line. Claims are often rejected because an incorrect or inadequate ICD-10 code was used. Document patient visits in detail and choose the most specific ICD code for a treatment. Always check, double-check and triple-check the all codes are accurate.
4. Data entry errors
These are the easiest mistakes to make and the most frustrating because they can be easily prevented.
3. Overlooking changes in laws & regulations
If you don’t pay attention to the latest CMS updates and changes by subscribing to the “MLN Connects” newsletter, you may be missing some important information. The MLNs announce the latest CMS news and updates. For example, maybe you missed that starting January 1, 2020, you must start using the Medicare Beneficiary Identifier or your claims will be rejected. Subscribe here.
2. Not being prepared for PDPM & PDGM
As of October 1, the new Patient-Driven Payment Model went into effect for skilled nursing facilities. Home Health Agencies will get their own payment model update, in the form of Patient-Driven Groupings Model (PDGM), on January 1, 2020. Both are bringing a major transformation to billing processes and revenues for every SNF and HHA. If you want to avoid reimbursement scares, check out eSolutions’ resource pages to help give you a better idea of how to handle the changes brought by PDPM and PDGM.
1. Failing to collect patient information
The healthcare revenue cycle starts at the initial point of contact between a patient and a healthcare provider. This is the most important step that lays the foundation for care, billing and reimbursement. So it’s important to get it right.
Be prepared. Ask how we can help!
Don’t let these common billing mistakes keep you up at night. Avoid claim nightmares with eSolutions. Our powerful, easy-to-use revenue cycle and workflow management tools, paired with our actionable data analysis and insights, improve efficiency, minimize denials and reduce time to revenue for our clients. For more information, visit https://www.esolutionsinc.com/solutions/