How To Avoid Billing Errors
You can reduce billing errors and rejected claims, even amidst the learning curve of ICD-10. Here’s an overview that tells you how, beginning with an explanation of coding in general.
Rejected vs. Denied Claims
A rejected claim, not as serious as the denied claim, contains mistakes that prohibit the bill from being processed. These claims are returned for rewriting and can then be sent again by the biller.
Denied claims are eligible to be processed and then marked as not payable. The reasons are manifold: there could be term violations of the insurance policy, or some other invalid error. What the biller gets back is a reason for the denial, and the chance to resubmit. When bills go through a clearinghouse, they’ll scrub the bills, which helps the chances of claims being accepted on one try. That’s important because every bill that is rejected or denied costs you resources to resubmit.
During the scrubbing process, all of these data points are checked:
- Patient vital and residential data
- Provider data
- Insurance provider data
- Bad coding - including the unmatched and incorrect codes
- Incomplete coding
- Double Billing - when the physician’s office makes another claim without verifying if it’s already been done
Getting into the Causes of Errors
Lack of Information
Sometimes there just isn’t enough data to create a proper bill. The information may be illegible, indecipherable or incomplete.
When a medical provider emplaces codes that amount to more services than a patient received, its called upcoding, and is illegal.
Believe it or not, trying to save a patient money or avoid an audit isn’t legal either. That happens when a medical provider leaves out some of the coding for services rendered, either through coding a less substantial procedure, or omitting certain codes altogether.
Explanation of Benefits is something the payer is supposed to attach to a denied claim. When that doesn’t happen, getting to the bottom of why they claim was denied is difficult.
Staying Up to Date on Billing
Everyone is having an uphill battle with ICD-10.
The best way to do this is to speak with other billers. Scouring the internet for the information that you need may be time consuming and bring you mixed results. The best way is to cut straight to the source. You have a wealth of knowledge at your fingertips in your own community. Arrange for consultations with fellow billers at hospitals, clinics and private practices.
The other people to speak with are those in your own offices - your doctors, providers - anyone who will help you identify the best information to send on a claim.
When you check and recheck, you’ll, be less likely to let errors go. It’s easy to miss numbers and letters, so revise your work.
Speak to the people who are actually working on your claims, and you can find out if they’ve discovered errors that you can work to correct before you’ve even received a rejection or denial.