Page 38 - Deleware Medical Journal - September/October 2019
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Is Your Practice Losing Money on These Common Billing Errors? Here’s How to Fix That
Tina Irgang Leaderman
ball. Insurers say it’s your responsibility to check eligibility before you treat.”
BILLING OUTDATED CODES
“Sometimes I’ll go into a practice and they’ll have old [coding] books,” says D’Souza. While coding books can run into the hundreds of dollars, it’s a critical expense, he adds. “You might be missing out on money by billing codes that are not valid anymore. There also might be new codes for screenings you can now bill for.”
If your practice bills an incorrect or outdated diagnosis code, “you have to pay people to work on the claims on the back end. If you’re proactive, you don’t incur those costs and you get the compensation you deserve.”
BILLING TWICE FOR THE SAME SERVICE
Duplicate billing isn’t necessarily a sign of fraud. Groux recalls a cardiology practice with “an enormous amount of duplicate claims within a period of 45 days. They incorrectly. To correct it, they resubmitted the whole claim, and the line items that had been adjudicated came up as duplicates. You rather than resubmitting the whole claim. Again, you’ll identify that by reviewing the EOBs.”
A related issue is bundling. If your billers are not aware that a certain procedure is included as part of a bundled code, they may also bill for the procedure under a separate code. If the separate code is genuinely warranted
— such as because you performed the same procedure on two different anatomical sites — your billers can let the payer know by
In a perfect world, you’d focus on nothing but patient care all day. But the fact is that, like any business, a
physician practice can’t afford to leave money on the table. Unfortunately, that is just what many physicians are doing.
your billing broccoli every once in a while. “Ultimately, the physician is in charge,” says Rohan D’Souza, MBA, CPC of D’Souza & Associates, Inc. in Hockessin. “A lot of times, physicians haven’t been taught the billing and coding mechanisms. But that’s not an excuse. They need to be involved in the billing department. They should be meeting with their billing managers.”
In addition, physicians need to make it a point
says Cindy Groux, CHBME, president and CEO of Health Care Practice Management, Inc. in Wilmington. “That’s really where all the trends and patterns are coming from,” she says. “They have to look at their denials and if they don’t understand them, have someone come in and look at them who can understand them.” Ideally, physicians should review EOBs weekly, she adds.
Here are some common reasons physicians’ claims are rejected or denied, and tips on how to address the underlying issues.
BILLING THE WRONG PAYER
Groux recalls a client who brought her in to address billing issues. “It turned out that 44% of the denials in the last six months were based on a front-desk issue,” she says. “They were not checking eligibility, so the practice billed the wrong payer. Three of the physicians’ employees didn’t even have logins to check eligibility. It was a real eye-opener for the practice.”
Pay particular attention to Medicare patients. Sometimes, patients may have switched from standard Medicare to a Medicare HMO without being aware of it. “Unbeknownst to them, a family member can do that,” says Groux. “So train
your front desk to ask the appropriate questions, and then still verify before you treat them. The patients will tell us they have Medicare, but they aren’t covered. a Medicare HMO. ... By the time you get a denial, you’re already behind the eight
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