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3 Medicaid Billing Issues NEMT Providers May Face

Medicaid billing issues

Medicaid billing is the backbone of non-emergency medical transportation revenue cycle management. But Medicaid billing isn’t always simple, and many providers face significant challenges during the billing process. It’s crucial that all claims are processed accurately, but unfortunately, there are many obstacles that can prevent that from being the case. One of the biggest billing problems with NY Medicaid is making sure all information is correct according to state guidelines. Every state, from Kentucky and Texas to South Carolina, uses its own set of billing codes, and if providers are billing manually or with faulty software, it’s very likely that errors will be submitted. Since NEMT providers transport patients to:

  • doctor’s offices
  • hospitals
  • rehabs
  • and more.

There are many different codes and data to keep straight when billing. Here, we’ll discuss the 3 most common billing errors and how to prevent them. 

Rejected Claims

Rejected claims are one of the most common billing issues for Medicaid. Rejected claims are those that contain one or more errors, therefore can’t be processed. Once these errors are found, the claim is returned to the provider with an explanation of the error so it can be corrected and resubmitted. 

What causes them?

Rejected claims are typically found due to clerical errors, mismatched procedures, or ICD codes. But another huge cause for rejection comes from patient ineligibility. It’s the job of front-end staff to confirm a patient’s health insurance status and coverage to prevent rejections. 

Research by ClaimRemedi found that payers reject more than 7% of claims due to ineligibility. This is because often, providers didn’t ask patients the right questions.

Since the medical billing process technically begins at the first point of contact, it’s important for front-end staff to diligently collect every piece of information they can right from the start. It’s easier to get information up front than to have to press patients for missing data later on. 

How to prevent them

The best way to prevent Medicaid billing issues, like rejected claims, is with a reliable billing and clearinghouse software. Claimgenix billing software checks all claims for errors before submitting them to avoid rejections. This prevents providers from having to make changes later on, saving the business time and money. While it’s still important to get correct information up front and double check billing codes and data, it’s nice to have reliable software to fall back on. After all, human error is common, especially for providers who look at dozens of claims throughout the day. 

Denied Claims

Denied claims are ones that have been processed by the payer but deemed unpayable. Like rejected claims, payers will send them back to the provider with an explanation of the problem, and payers can correct the claim and resubmit for processing. Unfortunately, this process takes up more valuable time and can set your business back. Plus, if you’re submitting paper claims, your payment date will be pushed back even further. It’s important to invest in medical insurance billing software to avoid errors and receive reimbursements faster than ever before. 

What causes them?

  • Claims may be denied for a variety of reasons
  • One of the most common reasons is due to patient ineligibility, however other reasons like incorrect patient or provider information, insurance information, and codes are also common problems.
  • Coding is a confusing aspect of billing for many providers, since every state uses a different set of codes.
  • That’s why regular ICD training is valuable for all NEMT businesses. 

How to prevent them

The right billing software is the best way to prevent claim denials. Claimgenix scrubs claims for errors before they’re submitted to prevent denials. With our EDI billing software, providers are far less likely to face problems with claims, and will save time and money because of it. Don’t rely on manual billing or faulty billing software to submit claims. Make the smart switch to Claimgenix for reduced errors and faster reimbursement times.  

Incorrectly Paid Claims

Incorrectly paid claims are exactly what they sound like. They may come in the form of an underpaid claim or sometimes no payment at all. This can become a huge setback for companies, since identifying the problem, correcting it, reprocessing claims, and receiving proper payment can take weeks or even months. While some companies may choose to take the loss rather than correcting and resubmitting the claim, this is a huge blow to the business’s profit, even if it only happens a few times. 

What causes them?

The biggest cause of incorrect payments is the use of wrong billing codes. Providers deal with dozens of claims every day, so mistakes are bound to happen. Add in the fact that each state uses a different set of codes, and it’s easy to see why errors occur. While it’s common for claims with incorrect codes to be submitted, it can become detrimental to your business if it’s a regular issue. 

According to sources, incorrectly or mistakenly coding a medical service will likely lead to an uptick in claims denials, so healthcare organizations should regularly train clinical staff on ICD-10 coding updates and encourage front-end staff to communicate with clinicians if there are documentation issues.

How to prevent them

Claimgenix Medicaid billing software is a smart investment—one that works hard to make sure every claim you submit is a clean one. Take the risk out of billing Medicaid with a software that scrubs every claim for errors before submitting, and feel confident that you’ll receive payments accurately and on time. 

Final Thoughts

NEMT providers face the complications of billing Medicaid claims every day. The success of their business depends on getting claim reimbursements as quickly as possible, so it’s important that they have the most efficient billing process possible. Claimgenix automates the Medicaid billing process for faster, more accurate claim submission and reimbursement. With our medical electronic claim software, providers can be certain they’ll get paid quicker than ever before. Don’t wait to make the switch to reliable billing software. Subscribe today and commit to better billing with Claimgenix!

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