Claims processing is a crucial aspect in the field of medical billing. When claims processing isn’t done correctly, it can result in those claims getting either denied or rejected. This forces you to fix those claims before you can resubmit them, all the while losing revenue for your medical practice. That’s why avoiding mistakes in the claims process is so important, and knowing what these mistakes are will help you avoid them in the future. Here are mistakes that you’ll want to avoid during claims processing.
Modifiers are Missing or Inaccurate
Certain billing services might make you use specific modifiers on the medical claim. You can tell which modifiers are needed by referencing the payer guidelines. When you don’t use the right modifiers during claims processing, your practice will face claim denials.
Duplicating Medical Claims
You don’t want to submit the same medical claim multiple times. If you do, your facility will start bringing about fraud alerts, which can cause payment holds. That’s why you want to keep track of the submission statuses of all of your medical claims. Keeping track of your submissions will help you avoid sending any duplicate claims on accident.
Unbundling Medical Services When Bundling is Possible
Bundling medical services when appropriate is a necessity for medical practices. It’s done not only to ease payment on the patient, but also to simplify the medical billing process. When medical services aren’t bundled, even though they COULD be bundled, this can also be considered a fraudulent act.
Mismatching Diagnosis Codes
When getting claims processing done, you want to use the most accurate diagnosis codes. When a medical claim doesn’t link the procedure codes and diagnosis, or the diagnosis codes are inaccurate, your medical practice will likely experience claim denials. The diagnosis codes that you use have to precisely reflect the medical conditions of the patient as referenced inside of their health record.
Bad Follow-Up Practices
A lot of medical practices don’t follow up properly after claims get submitted. This can lead to many claim rejections and denials going undetected, and these rejections and denials will need to get addressed afterwards.
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