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Medical Billing Mistakes Most Profitable Practices Avoid


Medical billing has always been a complex process especially because you need to make sure that everything is running smoothly. If you have a medical billing system that is either disrupted or if it is simply disorganized, then you are more likely to get less cash flow than what you had expected to have or get.

These common medical billing mistakes can end up derailing your entire payment process and in worse situations, you could also end up not been paid at all. Below are some of the mistakes that many profitable practices tend to avoid.


Disorganization

The number one mistake that any profitable practice is been disorganized. When the entire system is disorganized, then there is going to be a lot of chaos in the system. This chaos will lead to claims not been filed at the right time and in some cases, the claims may not be filed at all. Since most if not all payers have a certain time limit when it comes to paying, any kind of delay is going to be very expensive for any provider. When you finally get to sort out the situation and find the claim and try to submit it, chances are high that it is going to be denied due to the late timing. Ensuring that all your denials and claims are filled at the right time is one of the most effective ways of ensuring that the cash flow is in check.

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Not following up on claims

It is important for profitable practices to understand that having insurance claims that are outstanding will simply not get solved on their own. When you decide to neglect this kind of claims, then what you’re simply doing is making sure that money is just left on the table. Whether a particular claim had issues when it came to its transmission or whether there is a problem somewhere, not following up on the payments that are missing will ensure that you never know what is going on. Not following up or tracking unpaid and older claims will automatically end up directly affecting your profits and revenues.

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Having different employee training issues

As mentioned earlier, medical billing is very complex. With this in mind, having employees who cannot be able to comprehend all the components of an EOB could end up costing you a lot of money. A properly functioning EOB is able to tell you why you were not paid at the time you were expecting to and it can even let you know why the request that you made was denied. All your medical billing employees need to make sure that they are able to identify any problem that may arise and also take all the necessary steps so as to correct the problem.

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What is meant by authorization in medical billing?

What is authorization?

Authorization refers to the state when the health insurance plan requires a patient to get permission from the insurance provider before receiving certain healthcare services. If a patient seeks a service that required authorization then they could be denied coverage by the insurance company. An authorization can be given verbally or through writing.

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Why is an authorization necessary?

An authorization requirement is used so that you are able to receive only the services that are covered by your plan. It also ensures that you are able to receive services that are only medically necessary. This is so that patients do not go seeking for services that are not very necessary just to use up their insurance. Preauthorization also helps the provider to be reimbursed duly because they will not perform services that are not covered in the plan that the patient has.

How to deal with a preauthorization

The best thing that the provider should do is ensure that they have the required approval before they offer any services. After that they should obtain the correct CPT code for the billing procedure. Ensure also that the authorization number given if any is quoted in the billing process as might be required so that the services will be fully reimbursed without problems. Preauthorization is one of the major reasons why most of the health providers are not reimbursed for their services by health insurance therefore care should be taken when dealing with such a case.

If there was an emergency and the patient was offered services before the provider could figure out their coverage requirements, then the provider should contact the insurance company immediately after. The burden of obtaining a preauthorization falls with the health provider. Without the preauthorization, the insurer may not be obligated to pay and the bill may fall on the provider or the patient as defined in the insurance plan.

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Authorization is different from referral, another scenario in which approval is required before services are offered. A referral can only be given as a written document while an authorization can be verbal.

What is a Referral?

A referral is a written document that gives the go ahead from your primary care doctor for you to see a another healthcare specialist or get the services of a healthcare provider. This is common in many Medicare managed plans. This means that you will need to get a referral if you need services from anyone else except your primary care doctor or you will not get coverage from the plan.

If your plan requires that you get a referral, then you will need to provide a written document from you primary health provider.

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