Denials of surgical billing claims are often the result of simple mistakes and carelessness on the part of your billing staff, as well as not having a plan in place to deal effectively with denied claims. All too often the rejected claim lands right back in the lap of the person who may have made the error in the first place. How can the billing staff of your practice prevent these claim denials, and what should they do if this happens?
Here are six of the most common billing mistakes and how to keep them from happening again:
1. Duplicate billing – While this was more common in the days when claims were prepared on paper, it can still happen, even with today’s more sophisticated billing software. Be sure that your billing staff are inputting the correct date(s) of service as well as charges. Another variation of this is billing for work that was canceled and never performed. Your staff needs to be aware of any cancellations in scheduling or professional activity to avoid having it show up as a charge.
2. Upcoding – This occurs when a more expensive drug or procedure is billed than what was actually prescribed or performed. Your notes and other patient care documentation should agree with the actual diagnosis and procedure codes being used. Keep the channels of communication open with your billing staff and encourage questions if they have billing or coding concerns.
3. Inflating operating room charges – Inflating surgical procedure, anesthesiology or other charges is a serious action that can land a practice in legal trouble, even when done unintentionally. Charging for more anesthesiologist’s time than his or her records show was actually used, is one example. If this happens you may find your billing practices under legal scrutiny from disgruntled patients and their families. Be sure that your actual time and equipment as well as procedures match completely with what is being charged.
4. Inaccurate or missing dictated and written information – The coder and biller can only bill for what is in your notes and dictation. It is important that you include all pertinent information related to a diagnosis, procedure or prescription to reduce the chances of this happening. Again, keep the lines of communication open between you and your billing staff, and encourage them to ask questions if they see something that could create a denied or investigated claim.
5. No system in place for handling denied claims –Unlike a family or dermatology practice, you usually perform fewer services, resulting in the need for every single claim sent out to be ‘clean’ and payable. When a claim is denied, you and your staff need to review all denied claims and determine the reason(s) for denial. If the claim should otherwise be payable, and the pattern of denial continues, it would be prudent to set up a conference with you, your office administrator and the insurance carrier involved.
6. Overloading your regular office staff with coding and billing tasks – Expecting one or two people to be proficient in billing or coding, among all her or his other administrative tasks, is asking for trouble. Mistakes by an overwhelmed clerk are bound to happen, and can have serious and expensive consequences for the practice.
M-Scribe Technologies, LLC, has been providing surgical and other practices with the peace of mind that comes from partnering with a leading medical billing, coding and documentation services company. Contact their experienced and dedicated staff to learn how M-Scribe can prevent denied claims, saving your practice time and money.
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