Few things are more frustrating than providing care to a patient expecting fair payment in return, only to be informed that your Urology medical practice coding and billing claim is being denied because the payer doesn’t think the service was medically necessary.
You’ve ensured your revenue cycle management process is up to speed, or so you think. Yet, you’re still faced with a good percentage of denied insurance claims. And it’s beginning to affect your bottom line because your medical practice reimbursement is taking a hit. What’s going on?
While there are plenty of reasons an insurer might deny your claims, the most common billing errors are also the simplest and easiest to correct. Did you know top claims denial reasons continue to be patient registration-related?
Here are the top three errors:
1. Incorrect and/or incomplete patient identifier information (e.g., name spelled incorrectly; date of birth or soc. sec. number doesn’t match; subscriber number missing or invalid; insured group number missing or invalid)
Solution: Verify patient demographic and insurance information at EVERY visit. Ask permission to photocopy the patient’s state-issued identification (passport, drivers license, etc.) and insurance card, so that you are sure to have the proper spelling, group numbers, etc., on hand.
2. Coverage terminated
Solution: Verify insurance benefits prior to services being rendered.
3. Services non-covered/Require prior authorization or precertification
Solution: Here again, you should contact the patient’s insurance and confirm coverage prior to services being rendered. You’ll end up with angry customers if you bill a patient for non-covered charges without making them aware that they may be responsible for the charges before their procedure.
What physicians and their office managers tend to forget is that it’s not all about what the billing office is doing right or wrong. It may be related to their first line of defense, the front desk. A little focus on the front end of the revenue cycle makes a big impact on the end result and ultimately the practice’s ability to get paid for all of the services rendered. With everyone on board implementing the following best practices, you will help improve your registration quality and point of service collection, and yield measurable improvements:
1. Recognize that registration is a financial function.
2. Pre-register information.
3. Verify benefits and eligibility at least 48 hours before the patient’s appointment.
4. Secure payment of all patient responsibility amounts at the time of service.
5. Perform quality assurance audits on registration staff and processes.
Reducing your number of denied claims also requires the special expertise of certified coders providing attention to detail, exacting accuracy, quality control, legal compliance, years of industry experience and an in-depth understanding of Urology medical coding and billing nuances.
For coding that unleashes your full revenue potential, all roads lead to the Urology medical practice coding, billing and compliance experts at revMD.com.
revMD.com is the results-proven alternative for healthcare revenue cycle management, with a niche specialization in urology medical coding and billing that generates unprecedented results and builds profitable medical practices. Leveraging a history of industry wide success spanning 26 years, revMD.com partners with medical practices throughout the U.S. to optimize revenue for hospital based and practice based physicians. For more information, visit www.revmd.com.