There are a lot of things that can go wrong when it comes to ENT billing and coding. More and more practices are now turning to the assistance of healthcare consulting companies like MD Pro Solutions to help them with billing, coding, insurance verification and all sorts of account receivables management. In some cases, outsourcing billing and ENT services can be the best solution. Practices and clinics can use that time to properly train and educate staff, while ensuring that cash flow is retained, allowing their billing department to get back on track with all the latest requirements from insurance companies, ICD-10 changes, and other healthcare industry changes.
It is important to know “when to say when” and bring in a consultant who specializes in otolaryngology that can help you get your practice back on track. Learning proper coding and billing practices helps to avoid denied and rejected claims, which can bring cash flow to a screeching halt, cause more lost man hours in resubmitting claims, and reduce the amount of time that staff can spend assisting patients. MD Pro Solutions offers a wide variety of educational, training, testing, and support services to help improve ENT billing and coding. It is essential that you hire healthcare consulting companies who can provide you with all of the services and support you require.
How Claims Are Denied & Rejected
When you think about problematic claims that are denied and rejected by payers and Medicare, what do you think went wrong? Sure there are cases where outright fraud comes in to play, but in most situations, it really is a result of poor billing and coding management by the practice or clinic. Proper account receivables management, insurance verification and learning how to match diagnosis and procedures with the right coding is more important than most practices realize. It pays to get your staff the ENT billing and coding coaching and support that they need or to turn it over to someone who can handle it for you, through outsourcing billing ENT services.
The top causes of denied and rejected claims are quite simple. They often include the following:
- incorrect provider information – wrong address, contact details, misspelling of name, etc.
- incorrect patient information – date of birth, insurance ID number, misspelling of name, etc.
- incorrect procedure coding – confusing codes, place of service codes, conflicting modifiers for CPT codes, too many digits or too few digits for ICD codes, mismatched codes, etc.
- duplicate billing – poor account receivables management and billing procedures
Billing accuracy is extremely important to the success of your ENT billing and coding department. If your staff does not have the training and education require to meet the standards of today’s billing requirements, they won’t be able to perform simple tasks, such as proper insurance verification and Medicare coding. This will reduce the abilities of your overall account receivables management and could end up costing you in the form of time, money and lengthy delays. You might even be subject to more serious situations if your billing errors keep occurring. Your best bet may be to obtain training and support for your staff, while turning to outsourcing billing ENT services while they receive the education they need to make improvements.
Other Types of Errors
In addition to the errors listed above, there are still other errors that can cause a claim to be rejected or denied. It is important that you know what to look out for and avoid with regard to ENT billing and coding, so you can ensure steady cash flow and proper account receivables verification. Healthcare consulting companies can help you get all of the training and online support that you need, perform reviews and offside CPA audits – whatever it takes to get your billing department on-track and working as it should.
Other problems to be on the lookout for with regard to erroneous coding can include:
- documentation – when a practice provides illegible, incomplete and incorrect documentation regarding procedures that occur during a patient’s visit, it makes it difficult for ENT billing and coding to be accurate when filing a claim; sloppy or incomplete documentation can be corrected by training physicians and medical office staff to be more accurate in their patient visit documentation for better billing practices
- undercoding – practices lose money when they leave out procedure codes or improperly codes for less extensive procedures; this is done for many reasons, such as trying to avoid audits, save money for patients, etc., but it is considered to be a type of fraud as it is illegal to intentionally change codes in any way
- upcoding – sort of the opposite of undercoding, upcoding is another type of fraudulent charge where the provider misrepresents the type of work or extent of the work that was performed on the patient intentionally; adding codes for procedures the patient never received or marking codes for procedures that were more serious than what was done; practices do this to get more money from the payer and this is illegal
How to Avoid Denied & Rejected Claims
Provide your ENT billing and coding team with all of the training, education and support they require to stay on top of changes that occur within the industry. Make sure they are adept at insurance verification and other essential duties for account receivables management. If you have a small practice or are under-staffed, consider outsourcing billing ENT services to healthcare consulting companies like MD Pro Solutions that can help you boost cash flow and keep claims submissions at a steady pace. Call our team today for a FREE consultation or to find out more about all of the services that we provide to otolaryngology practices and clincs at 508-946-1665.