Many insurance plans now cover substance abuse treatment. This includes both private insurance and public insurance, like Medicaid. While the coverage varies from plan to plan, the fact that it exists at all is a huge step in getting people the help they need. However, billers in this field have had a lot of trouble getting paid what they owe, resulting in lost revenue across the board. The following are the top problems billers face when billing these claims:
Any amount of incorrect documentation will result in a rejected or denied claim. Something as simple as a misspelled name, incorrect insurance coverage, or one blank field will deem the claim unpayable. The good news is, these things are almost always fixable, but waiting too long to correct the mistake could cost your practice valuable time and money.
Failure to use the most up-to-date ICD codes
ICD-10 is comprised of thousands of different medical codes, with new ones being added constantly. If your billing department isn’t on top of the latest changes, it’s easy to accidentally submit an outdated code. An incorrect code means your claim will be denied, so having a way to keep up with the latest codes will keep your billers sharp and your errors minimal.
Upcoding and undercoding
Upcoding means a claim is submitted for a higher amount than it should be, while undercoding means the bill is lower than it should be. Both can happen unintentionally, where a service is either added or left off by accident. However, there are instances where billers have been found guilty of doing this on purpose—a highly illegal practice. Using fully integrated medical billing software is a great way to prevent upcoding and undercoding.
A duplicate claim is an exact replica—a claim billed on the same date for the same service. As expected, the same claim can’t be paid twice, and since insurance companies don’t know where the error is, the claim will be returned as rejected for your billers to fix.
No insurance verification
Patients change insurance providers and plans all the time. As such, it’s important for staff to verify a patient’s insurance coverage before every appointment to avoid billing problems down the line. This is the case for both new and existing patients. Taking the time to check this information beforehand will save you lots of time later on.
A better software solution is available
Billing software is designed for a simpler, smoother billing process. Medical billing and coding software programs allow healthcare providers to run a better business, saving them time and money every day. For more information, get in touch with the Claimgenix team to see how your practice could benefit.