Common Reasons That Causes Claim Denials

It can get frustrating when claims are denied, but if the incident keeps occurring in your healthcare facility or organization, you may want to take a look at your processes and the way they are handled in your office. Timing issues, errors, and input oversights are among the reasons why some claims are denied. By being mindful of these incidents and following HCC medical coding standards, you could minimize denials and improve your approach to billing.

Hierarchical condition category (HCC) and risk adjustment coding is the payment model that identifies patients with chronic or serious illnesses, then designates a risk factor score to them according to factors like demographic details and health conditions. HCC medical coding was implemented in 2003 and mandated by the Centers for Medicare and Medicaid Services (CMS) in 1997. A patient’s health condition is identified using ICD-10 (International Classification of Diseases-10) diagnoses, which you submit to insurance companies when filing a claim. There are over 9,000 ICD-10 codes being mapped to 79 HCC codes.

HCC medical coding errors are among the reasons why claims are denied. By working with a seasoned team of AAPC-certified medical coders, you could minimize those mistakes and increase the accuracy of your claims. All coding must be audited before the charts are finalized. Claim denials may also occur when the claim is not up to the insurance company’s standards.  So, you need to make sure that the claims are made according to their regulations and that they are legible, specific, and complete with all the information required.

Missing information is another reason why a claim can be denied. Even a small detail left out can cause problems later on, especially when you are dealing with a detail-oriented insurance company. Keep in mind that some payers will look for minor specifics, such as the date of the medical emergency, onset, and the accident. A claim can be denied if it is not filed on time. Some providers of HCC medical coding services have a team of specialists who will make sure that the claims are submitted on time.

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Accounts Receivable Management: Top Tips to Get You Paid

As much as you want to get paid immediately, there are unavoidable circumstances that might prevent Insurance Company from paying you on time. In some cases, you might encounter an insurance company denying a claim. While there is no way to ensure that all claim can turn into money, you can minimize denials and inefficiency by considering account receivable management. It may sound complex, but it is actually simple when you work with the right billing partner, which you can outsource to save money and effort. Here are some tips to make accounts receivable management work for you:

• Outsource the service – An established and reputable medical billing company will provide you with an effective and highly trained AR team that can address the challenges in your cash flow. Their goal is to help you recover the funds owed to you as quickly as possible by accelerating cash flow and minimizing accounts receivable days by providing clean and error-free claims. They can analyze denied claims and regularly follow-up with patients and insurance companies on your behalf in case of any outstanding dues and claims.
  
  
• Do not wait – Go after late payments as soon as you notice them. The longer you ignore them, the more difficult it will be to collect. Accounts receivable management can help by following up, so you can focus more on your business.

• Follow-up insurance – Medical billing companies and healthcare providers lose money due to their inability to follow-up on any outstanding claims. When you lack manpower and the time to process insurance claims, you could risk losing a lot. So, consider working with a good Account receivable management team for assistance. Medical billing partner can aggressively follow-up all accounts with insurance companies to ensure the quick settlement of claims. They have the ability to monitor accounts receivables, too.
  
  
• Clean-up old accounts – Unresolved accounts receivables occur due to insufficient follow-up as a result of low manpower and backlogs. Account receivable management still analyzes previous reports and come up with ways to reduce debts and maximize collections.

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Medical Billing Codes: A Key to Fraud Case

Mistakes in medical coding and billing can negatively affect practice revenue in various ways. They can disrupt your cash flow and take your attention away from your core function of providing high quality care to patients. They can even possibly lead to fraud charges, which will harm your reputation and practice. Making a mistake and actually engaging in fraud are two entirely different things, of course. However, if the mistakes seem habitual and claims are always getting rejected, suspicions may arise.

Health insurance frauds happen when a practice intentionally submits incorrect claims with the intention of getting paid for services that weren’t actually performed. Physicians who bill excessive charges, submit a huge number of claims, and perform unnecessary services may be charged with fraud.

Investigations on fraud charges can take years. They can also cost a lot and result in the revocation of a physician’s license. Hence, it’s prudent for doctors and other healthcare professionals to always be careful when submitting claims. All activities must be well-documented and all rules and regulations should be strictly followed.

The truth is that committing errors and being fraudulent are no different from each other; you may still face charges whether your mistakes were honest or you actually engaged in fraud. Medical coding and billing should be taken seriously, and any errors should be quickly acted upon. At the same time, it is also important to evaluate and correct the factors that are causing these mistakes to happen.

To make sure such errors are minimized and fraud charges are avoided, it will be best if you just outsource medical billing and coding duties. That way, you will have access to trained and experienced professionals as well as a comprehensive range of services. Outsourcing healthcare services is more efficient and will help you save money. When you outsource to a reliable company, you and your staff will be able to focus more on providing quality health care to you patients.

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How Outsourcing Medical Billing Overcomes Medical Billing Pitfalls

Medical billing is a complicated and extremely demanding process and it can be difficult for a practice to deal with all of the tasks involved. The billing function possibly takes up a huge chunk of your support staff’s time—time that could be better spent caring for patients. The good news is that you can choose to outsource this process. By outsourcing medical billing, your team will have more time to deal with other important responsibilities as a healthcare provider while reducing billing mistakes.

Rules and procedures in medical billing are constantly changing. This means that if you won’t outsource medical billing, you will have to consistently spend time and money in acquiring new software and training your staff on the Industry changes. For a practice that needs to take care of a lot of other responsibilities, constantly keeping up with these rules and regulations can be too taxing.

It’s more practical to simply outsource medical billing to a reliable company so you can leave the task to professionals. Medical billers are always on top of things; it is their job to comprehend and implement new rules thoroughly. As long you are confident that you have chosen the right company and professionals, you can trust that these billing rules will be followed.

Because of ICD-10, everyone is worried about getting coding errors and are thus taking much longer to double check their coding. This puts a lot of pressure on a practice’s support team and takes time away from other functions that need attention. More time taken up by coding also means less time for billing. This results to rushing—and that’s when mistakes happen.

Outsourcing medical coding and billing prevents errors from happening. Medical billing companies are focused on getting everything right, and they’re less likely to commit mistakes because this is the core of what they do. They also have ample knowledge and the right equipment to see to it that bills and claims are processed quickly.

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Rectify Your Patients’ Health Information with Document Management System

Administrative costs account for over 25% of the total expenditures of healthcare clinics and hospitals. A large portion of this goes to paperwork involved with billing, coding, records, and insurance. Each patient visit adds to the already voluminous paperwork healthcare providers have to deal with on a daily basis. What’s more is these medical facilities are obligated to maintain all these records for at least 10 years after any patient’s final visit. With the amount of information that practitioners have to manage, how do you ensure your own practice’s reliability, accuracy, and efficiency in keeping patient records?

Many healthcare providers are discovering the benefits of digitizing their patient records and other related paperwork and adopting the appropriate document management system, which, in a lot of ways help reduce the cost of paperwork management and at the same time ensure document processing speed and accuracy.

Cost efficiency is one of the most obvious benefits of document management systems. Facilities that have already switched to digital record keeping systems cut spending substantially in terms of reduced material and equipment costs, reduced storage needs, reduced retrieval fees, and smaller staffing costs. Well-designed document management systems also ensure information security and regulatory compliance. Paper documents are prone to damage due to natural disasters and accidents, ranging from mold to fires, flooding, and other incidents. Physical damage to paper-based documents are usually irreversible rendering patient information non-recoverable. Electronic document and file systems have redundant storage features and highly efficient disaster recovery solutions, making sure that all information stored can be recovered one way or another. Even when a particular server fails, there are digital backups that practitioners can turn to so important information can be recovered when needed.

Document management systems also provide a level of protection no paper-based file system can offer, that is a detailed chain of file custody, wherein timestamps and employee names are recorded on each stage of the document processing. This means extensive protection of patient information confidentiality.

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An Essential Tool for Efficient Practice Management – Medical Billing Software

Practice management will be less stressful and tedious with the help of the right tools. No matter the size of your operation, any medical practice entails a lot of complex processes to keep up with. Streamlining different aspects of your operations should help simplify your practice and allow you to focus on what you do best—which is providing your patients the care they deserve. Discover the many great advantages of practice management solutions by letting electronic medical software and medical billing programs do the work for you:

• With a medical billing software, you can automate many time-consuming aspects of the billing process, ranging from invoicing to claims processing. Electronic medical billing is the future of any medical practice and it is exactly what sets today’s clinics apart from traditional doctor’s offices.

• Transactions are made easier and faster as medical billing services help reduce excessive paperwork traditional medical billing processes require. With your own customizable program, you reduce tedious paperwork without compromising patient records, claims, and billing records.

• Medical billing software programs do require a substantial investment, but the upfront cost is a small price to pay compared with the efficiency that they bring to practices. Overhead expenses are also reduced as they eliminate the need to hire additional employees to take care of the different steps of the billing process that medical billing software can all do with little human intervention. 

• Thanks to advanced technological integration, medical billing programs also allow fast and easy access to all data and patient information a medical practitioner needs. With all essential data kept in a central location, you have access to the information you need anywhere and anytime you need them.

• Finally, medical billing software programs help reduce error margin as there is less manual work involved. The best programs can even be customized to fit your office’s workflow, helping you reduce errors while ensuring all your billing needs are met.

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Important Steps When Processing Medical Billing Claims

Here’s a fact: hundreds of millions of claims are denied by insurance companies in the US every year, amounting to billions of dollars. If you don’t have an efficient medical billing claims system, just imagine how much money your medical institution or healthcare organization is losing. Perhaps it’s time to review those rejected claims, get paid for them, and ensure that rejections are avoided in the future.

Steps in Proper Medical Billings and Claims

As much as healthcare should be a right, hospitals and healthcare practitioners still need money in order to do provide services. How do you ensure that your practice or billing company stays alive? Take note of the important steps when processing medical billing claims.

After servicing the patient, your hospital or clinic submits the claims to the insurance company. There are hundreds of insurance providers in the United States alone and the medical codes can be confusing, but you have to be meticulous because a single typo or wrong letter can cause a claim to be denied. After you submit the insurance claim, the insurance providers will process it according to the plan of the patient. Then they will reject or accept it.

In the event that the claim is denied, the first step would be to identify the reason for the denial. Common reasons for denied claims include incomplete information, coding errors and omissions, lack of prior approval, co-pay etc. By following up on patients and correcting claims, resubmitted claims can be approved to prevent aging claims.

Many of the most successful healthcare institutions and practitioners in the world have hired offshore medical billing companies to handle the insurance claims. By outsourcing your medical billing, you can save time, money, and energy. It will also ensure fast cash flow and shorter claim submission turnaround. One of the finest medical billing companies in India has over 16 years of experience, and they provide end to end medical billing services such as denial management, patient registration, AR follow up, and physician credentialing, among other services.

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Details to Check during Insurance Eligibility Verification Process

The process of insurance eligibility verification is not as simple as cross-checking data. There are hundreds of insurance providers in United States alone—and they all update their plans frequently. Unchecked details lead to insurance claim denials. Unfortunately, many details fall into the cracks because hospitals, clinics, and other healthcare organizations often lack the manpower to focus on this task.

The best solution is to partner with an offshore medical billing company to prevent rejected claims. By partnering with an offshore medical billing company, your billing company or physician group saves time, energy, and money. Offshore medical billing companies in India are affordable, and since they are doing all of the medical billing, you gain more time to focus on your Client Service or patients based on your business. However, choosing the right business partner is essential in the offshore space!E-care has over 16 years of experience. We offer end to end medical billing services, from insurance eligibility and benefit verification, Demo Entry, Coding, Charge Entry, Transmission, Payment Posting, Accounts Receivable and denial management, patient registration, indexing medical records, and much more. We are ISO-certified, a member of the HBMA or the Healthcare Business Management Association, and comply with the regulations and the latest HIPAA rules.

When we go through the process of insurance eligibility verification, we receive the schedules of the patients via email, fax, or EDI. We make sure to verify the Insurance for patients two days or more prior to the encounter depending on the requirement from our client. We have highly skilled and experienced team who is capable of maintaining the TAT and accuracy over 98%!

Our team may also regularly check the schedule through the appointment and scheduling software. The next step is to verify the patient’s insurance coverage with the insurance company. This involves making calls to the insurance providers, speaking with the insurance representatives or requesting fax through IVR and checking information through their authorized insurance portals online. If need be, we contact the patients for more information. Post which, the team updates the billing system with the details of eligibility and benefits verified, such as the co-pay, coverage period and identification (member ID, group ID, etc.) The team also input other information such as deductibles and other benefits information including maximum limitations. In the event that there are issues arising from a patient’s insurance eligibility, the client is informed as soon as possible. This streamlined process will considerably reduce rejected and delayed claims and increase practice collections. It also shortens your revenue cycle.

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Healthcare Billing Solutions - A Must Have For Today's Healthcare Industry

The operational success of healthcare service providers hinges on the financial ecosystem. It is important that cash flow is maintained so as to keep the operations running smoothly. Healthcare billing solutions are rightly touted as the best foot forward for the sector. A large number of healthcare providers rely on outsourced billing solutions offered by service providers with commendable experience. Healthcare providers have witnessed better payment receivables due to adequate follow up action. Here is a quick preview of some of the reasons for the need of outsourcing healthcare billing.

Reduction in number of denied claims

Reputed healthcare billing service providers ensure that the number of denied claims is low by providing quality billing and coding. This is achieved by a twofold process – one, accurate Insurance and Eligibility verification before appointment date and two, effective and timely appeal of claims when denied. With extensive knowledge on the process and the requirements, medical billing companies ensure that the appeals are followed up with trained and dedicated resources. This in turn reaps the benefit in the form of payment.

Controlling administrative expenses

With Healthcare Industry moving towards preventative care and encouraging Value Based Payments like ‘Fee-For-Service’, ‘Bundled Payments’ etc., it is highly important to keep the Medical Billing administrative costs under control. Administrative expenses towards the maintenance of a separate billing section involve huge recurring expenses. This is in addition to the capital expenses in establishing the section. Pay perks, employee benefits, office expenses, recruitment and training expense etc., the list is quite lengthy. Offshore Outsourcing medical billing services will dispense with all these expenses. This will leave the Practice/Hospitals with resources to focus on providing better treatment to patients and Medical billing companies based in US to focus on Client Relations and expansion!

Maintaining uninterrupted cycle of billing and follow up

Outsourcing medical billing maintains the process and cycle of billing. This is primarily because of the large number of trained and experienced professionals working on these processes. This is in sharp contrast to a key person quitting the job in the billing team which is literally unpredictable. With high attrition rates and churning experienced globally, it is inevitable that a key position may fall vacant. This will lead to backlogs and the need to train the inductee fully to start functioning without errors.

Faster payment cycles

Having a dedicated team to follow up on outstanding payments ensures that the cash flow is healthy.  Accounts receivable from insurance companies requires adequate follow up to ensure that it is received on time. Healthcare Medical billing companies follow streamlined processes to send the claim. The initial screening process and verification of information from the patient helps to generate the right bill. A claim that is correct in all aspects stands a bigger chance of getting first passed, rather than having to be denied for rework and resubmit.

Offshore Medical Billing Companies have been trusted the world over to enhance operations while creating better financial bottom lines. The efficiency with which the processes are concluded and reliance on the latest information technology has spurred the success of these organizations. Outsourced Medical Billing Companies have helped Medical Practice/hospitals to drastically cut down their expenditure in Medical Billing, benefitting from the economies of scale of operations.

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How Insurance Eligibility Verification Helps Medical Practices

With healthcare being linked to insurance in most cases, it is important to verify eligibility to ensure lower denials. At the pace with which administrative procedures are executed in healthcare, it is highly possible that incorrect or insufficient information is updated during billing. This results in a tedious and entirely avoidable process of denials and delays in clearance of claims. We take a closer look at the benefits of proper insurance eligibility verification in medical practice.

Reducing chances of claim denials and delays

Submission of incorrect, or inadequate information can be resulting in claim denials and unfortunate delays. This results in greatly impacting the flow of revenue in a negative manner. It is vital that bills and claims are accepted upfront without a round of delays that may play havoc with planned disbursals. This can be achieved through a process of proper verification of all information, and diligent cross checking prior to submission.

Reduce exposure to losses as a result of conclusive denials

An improper submission of bills and claims can often lead to a conclusive denial. Such instances of write off do occur as a result of practices that are not fully compliant with procedures. There is very little that can be done after write offs, and this can have a serious detrimental effect on financial health. ‘Prevention is better than cure’ is the adage to be followed in healthcare, and it is only natural that this extends to all areas of operations in a healthcare entity.

Staying abreast of policy changes of insurance companies

Insurance companies, like all other sectors often make changes in policy. These updates need to be factored into the verification process to ensure that the changed requirements are fully met. This will ensure that the claims result in securing reimbursement as sought. Staying abreast of changes also ensures that the least amount of time is spent on billing and receipt of claims.

Verifying insurance eligibility will help restrict unproductive actions and contribute to overall success of the organization. Streamlined processes followed as per updated procedures help to maintain efficiency and revenue flow.

e-care has great expertise in handling Insurance Eligibility and Benefit verification with all types of payers across States hence can help you to lower the denials and increase reimbursement.

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