Healthcare consulting companies are becoming more critical to medical practices because of the insight, support, and services that they can provide. It is important for medical billing personnel to have up-to-date education and training on subjects like insurance verification, billing and coding, and general account receivables management. The more information and support that your billing department has, the less likely they will be to have coding and processing errors when they file claims. A majority of the revenue received by most ENT practices and clinics comes from reimbursements made through successful claims submissions to insurance companies and other third-party payers. Any mistakes that are made can seriously cost your practice and result in serious cash flow delays.
Hiring Healthcare Consulting Companies
Before you hire anyone to help your employees to improve claims submissions and increase revenue, it is vital that you evaluate the services that they will be able to provide. MD Pro Solutions has over 45 years of experience in providing education and training, as well as outsourced billing and coding services, for Ear Nose and Throat (ENT) practices and clinics. Otolaryngology is our specialty, just as it is yours, and we work hard to ensure that your team has all of the training and support they need to succeed. Our services are designed to help our clients avoid the most common errors to minimize denied or rejected claims that can cause delays or gaps in payments.
We have helped clients that have brand new practices, who are just getting established and hiring in-house staff. We have also helped existing clients with many years of experience who are struggling to keep up with the latest healthcare industry regulation changes. Our team has also helped clients who are looking to make marked improvements in the way that they do business. So no matter what type of practice or clinic you operate or how long you have been in business, you can count on MD Pro Solutions to make sure that your team is ready for whatever changes and adjustments are required by industry regulators and the federal government.
Denied & Rejected Claims
There are a lot of misunderstandings about the difference between denied and rejected claims. At first glance, they sound like they could be talking about the same thing, but they are in fact quite different. A denied claim is a claim that has been submitted to an insurance company and has been deemed to be “unpayable” for a certain reason. In most cases, an explanation is provided in the Explanation of Benefits (EOB), which is attached to the claim. Some of the most common reasons to deny a claim is due to common billing errors and missing information, both of which could be avoided through education and training. It can also be denied based on patient coverage, which is why insurance verification is important. If you suspect that the denial came in error, denied claims can be appealed and, in certain situations, can be reprocessed.
Claims that are rejected get rejected due to errors. For example, an insurance company can reject a claim due to an incorrect spelling of a patient’s name or improper input of insurance information. However, once the errors are corrected and the claim is amended, it can be resubmitted again to be processed with the insurance company. Some of the most common errors include incorrect information for the provider, such as the name, address, and contact information, as well as incorrect information for the patient, including the gender, date of birth, or even the name. Mistakes are also frequently made by inputting the wrong codes or mixing up codes for ICD-10, point of service, or CPT codes, a well as missing a couple of digits in the ICD-10 codes. Mismatched treatment and diagnostic codes, missing codes for services performed by another healthcare provider, and other types of errors can result in a denied or rejected claim.
Contact MD Pro Solutions
If you are interested in learning more about our programs for education and training on anything from basic insurance verification to extreme billing and coding, give us a call. Unlike other healthcare consulting companies, we will not pressure you to switch your medical billing system, but will instead work with you to ensure that you are getting the most out of your existing software. Give us a call at 508-946-1665 to hear about the services available from healthcare consulting companies for you.