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How Medical Claim Denials Impact Your Practice

May 1, 2014

Claim DenialsWe all know that medical claims denials can cost medical practices revenue from the time and effort spent re-billing, but don’t overlook the possible penalties and fines levied on mistakes and misfiled claims that can also send your expenses soaring.

Medicare, especially, takes a dim view of recurring errors and coding omissions. Repeat offenders may be subject to investigation for fraud; there can be stiff fines and other penalties, not to mention the embarrassment and inconvenience of having your practice audited. To avoid this situation, read on to learn how to correct some of the most common mistakes made by billing departments.

Mistake #1: Failing to have the front desk ask for and verify proof of insurance coverage.

This is THE top mistake almost all practices make at one time or another. All it takes is a few minutes to ask for an insurance card and make a quick phone call or online entry. If no coverage exists then your staff will need to make payment arrangements with those patients at the time of services.

Tip: Many practices are installing patient portals that allow patients to take more responsibility for updating their patient information, including insurance.

Mistake #2: Billing staff training and competency levels haven’t kept up with industry changes and regulations.

Very soon, your practice will need to utilize the ICD-10 code change for all your billing. You need to allow time for staff to learn and practice applying the new coding, modifiers, and so on, to be up and running by the deadline.

Independent documentation and billing companies, such as M-Scribe Technologies, can also help with planning and implementing new and ongoing training via convenient webinars.

Mistake #3: Billing staff doesn’t utilize the full range of ICD and CPT codes and modifiers as well as accompanying documentation to ensure accuracy when filing claims.

This should be a no-brainer, but surprisingly, many practices fail to fully document and code commonly-denied claims, such as office visits or routine lab tests. The updated codes may take a bit more time to learn and apply, but are well worth the effort in better reimbursement rates from fewer denied claims.

Mistake #4: Medical practices not utilizing or updating electronic health records systems.

Good accounts receivables management includes the use of electronic health records (EHR), which can save your practice time and money by reducing the chances of duplicate claims – a common reason for denials, but software and other peripherals must be up to date on important regulation and procedure changes.

Your software systems provider should be on top of this before problems arise, but if not, your office or billing administrator can ask about the availability of upgrading to the latest versions. Computer hardware and related equipment upgrades are also justifiable expenses that will quickly pay for themselves in faster, more accurate billing and posting.

Mistake #5: Not utilizing the services and advice of independent medical billing and documentation services companies.

If your practice is on the small to medium side, it may be difficult to find and pay trained, experienced staff to handle your billing and documentation needs. You can save time, money and hiring and training headaches by turning those jobs over to a professional service, such as M-Scribe Technologies, LLC.

Contact M-Scribe today for a professional evaluation of your practice’s billing and documentation needs and watch your claims denial rate drop as your revenue grows.


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