As Ellen Risotti-Hinkle, a billing and coding consultant for VEI Consulting and also a member of AAPC, has stated, “There are a lot of things that can help a medical biller stay consistent with the changes as well as ensure that claims and bills are processed correctly.” He also said, “I am amazed by the few things medical billers should be doing but aren’t.”
Here are the 7 tips that every medical biller should be doing right now to ensure his or her practice’s success.
Know Your LCDs
Local Coverage Determinations Everyone in the billing industry should be familiar with LCS. Especially those associated with specialties and regularly billed services. LCD indicates whether or not a Medicare carrier will cover the procedure and under what conditions the procedure is deemed necessary. It can be medically necessary and also contain information on coding guidelines and reimbursement. Rissot Hinkle said that “knowing which of the diagnoses are considered medically necessary (i.e., payable) will also be helpful for the biller if he knows the patient should be signing an Advanced Beneficiary Notice. Knowing about any special coding guidelines is also useful information that can help ensure that claims are submitted correctly and reimbursed the first time.
Avoid Coding Errors
Medical billing company revolve around accurate coding and proper billing.
Having coding errors can cause a lot of issues in your medical billing company and prevent you from getting paid on time.
A simple coding error can cause problems that delay your payroll and reduce your overall cash flow. A coding error could be a simple decimal point off, and this may create huge errors that are detrimental to your medical billing company.
You need to focus on the details and communicate because careless coding mistakes are costly ones.
Working on Your Electronic Submission Claims
Submission reports are used for the verification of the claims that were submitted and received by payers. The reports also show which claims were rejected and what the reason was. Reviewing these reports will enable you to head off potential denials, as claims can be corrected and resubmitted immediately. Any claims that did not make it to the payer can be investigated, and the errors can be corrected as well. “It can take two to four weeks before a rejection is given if these reports are not investigated. When the payer never receives the claim, a denial is frequently never reported. “Working reports will help to resolve this problem and ensure that your claims are paid promptly.” Risotti-Hinkle stated
Know About Your Fee Schedules
There’s a mistake made by an insurance company in that if they reimburse the service at a lower rate than the fee schedule states, a large amount of revenue could be lost. If you know about the contracting amount that a payer should be reimbursing and are monitoring the payments received, you can stop this type of loss.
Work on Your Denials
As it is stated by Risotti-Hinkle, “Denials are the thing that is hated by the billers.” Maybe you don’t believe it but the insurance companies make mistakes, and the billers do as well. Perhaps the claim was properly billed, but the insurance provider erred and rejected it. Maybe a mistake was made when the claim was submitted. Don’t take things for granted. Look into it. Work on it. Whether it’s a “tickler” file or a work queue on the computer, billers should create a routine in which they work their denials. Follow up on any denials consistently until they are paid as they should be.
Don’t be Afraid of Appeals
The coding guidelines were not always followed by the payers. To expedite the processing of a claim, supporting paperwork must be provided. Don’t get afraid by appealing. Spend some time crafting your letter, gathering your evidence, and submitting your appeal to the insurance provider. “The outcomes can surprise you,” said Risotti-Hinkle. Nothing is more satisfying than getting paid for a claim you successfully appealed.
Cash flow is mandatory for the success of any practice, so completing the medical billing process on time and in an efficient way means you are submitting claims accurately and receiving proper reimbursement. Read the whole article to learn about the seven major ways to improve your medical billing company.