Maintaining a successful healthcare practice, both large and small whether you are running a primary care or specialty practice, a psychology or physical therapy or acupuncture practice there are several things you need to get right, including medical billing.
Medical billing is considered the backbone of the healthcare revenue cycle. While most medical establishments understand the need to bill there are many challenges in medical billing.
Insurance companies deny claims because of missing or incorrect information. A blank field or a little mistake like a spelling error can lead to claims denial. It is important to double-check every entry for accuracy. Using the right billing software can also minimize the chances of errors.
Problem Areas Involve:
1. Missing Documentation
You should integrate efficient medical billing software that makes attaching documentation easier.
2. Missing Referral or Authorizations
In many instances, patients are required to get a referral from their primary care physicians before accessing certain healthcare services. The absence of such referral or authorization from patient services can result in claim denial.
3. Services Not Covered
Sometimes patients are never aware that the service they need is no longer covered by their insurance until it is time for payment. You can overcome this problem by verifying patients’ coverage at every visit.
4. Improper Coding
Improper coding is one of the most common challenges in medical billing. The best solution for this challenge is to choose a medical management solution that offers coding automation.
There are several other challenges health facilities face when it comes to medical billing although these discussed here are the foremost. The Center for Medicare and Medicaid Services (CMS) actually hires outside audit corporations owned by private insurance companies to identify and address perceptions of fraud! They are privately owned “Medicare Administration Contractors” (MAC’s) that rely upon algorithms applied by professionals and non-professional in their attempts to identify fraud for the government.
Their investigation often begins with a request for 10-15 patient charts. If you get such a request, contact us immediately. At Birzon & Associates in Smithtown, we take great care to provide exceptional representation for a wide range of healthcare matters. Our knowledgeable lawyers have decades of experience assisting our healthcare clients in Nassau and Suffolk counties and are committed to helping you achieve your objectives.