Annually, the American Medical Association (AMA) comes out with new variations to the Current Procedural Terminology (CPT) code set, and it’s imperative to make sure your practice stays up-to-date on the latest coding updates. If have an in-house billing department then ensuring your billing and coding professionals educate themselves on the latest codes is essential. Keeping the billing personnel up-to-date on latest coding changes may require an investment. But it’s worth it to make sure they’re not becoming a liability by heaping up the claim denials file.
Denial Probers and How to overcome them
Verifying Patient Eligibility
The problem: The situation here is you won’t aware that the patient was unqualified for the services you already provided, and now how to face a denial from the insurance company.
Keep in mind that medical billing insurance claims often get denied because a patient’s insurance doesn’t cover the service you provided. Such encounters can happen if there have been policy updates to the patient’s insurance plan or the coverage has expired.
How to overcome it: To avoid such situation, the number one thing to do is verify insurance eligibility before treating a patient. Before you start giving healthcare services to the patient, it’s important asking them to contact their insurer to check for any recent policy updates. Make the patient call their insurance company and ask for a reconsideration. Otherwise, the patient or the patient’s employer could use their appeal rights.
Avoid Duplicate Billing
The problem: One of your orthopedic medical billing insurance claim got denied due to a duplicate service. While a duplicate service response can happen for many reasons, one common error is billing and coding mistakes or your in-house billing team may have submitted a claim more than once.
How to overcome it: Always review claims before submitting. Normally, insurers process the original claim and block successive ones. If your original claim has been administered, focus on recognizing and filling gaps within your billing team to avoid future mistakes. Otherwise, reach out to specialty medical billing and coding organization for a solution. Different payers have different guidelines for dealing with these situations, so your best people to work on those claim denials.
Input Correct ICD Codes
The problem: Your claim got rejected as someone from your coding team entered an incorrect ICD-10 code. Is your staff entering code with insufficient specificity as ICD-10 codes used today are more intricate and allow for greater detail compared to ICD-9?
How to overcome it: It’s extremely important for doctors to document patient encounters as expansively as possible. Keep detailed patient records with all health data, such as accompanying conditions, to better inform the codes you use. If you have the documentation to support the codes in your claim, you’ll be able to appeal a rejection.
