Common Pitfalls in Healthcare Billing and How to avoid them

Although every healthcare provider has a dedicated billing platform, but billing for healthcare providers is complicated and sometimes extremely frustrating due to the constant issues that keep cropping up. This means that your current billing platform simply cannot meet your needs. So let’s try and understand where the challenge lies. First of all, there is a burden on the office staff members to check and ensure that the claims being submitted have all the proper codes and all the documents pertaining to the claim are in place. This includes using correct CPT codes to prevent claim rejections or claims being bounced back to you unpaid. All of this is an additional cost to your that your clinic or office has to bear. Incorrect CPT codes can not only degrade the integrity of your practice, but repeated coding mistakes can also cause your practice to be flagged for fraudulent practices. And it can become challenging to prove that the billing mistake was not intentional. So, your office or clinic must have the correct processes to ensure that the coding is done correctly.

Additional issues arise for Mental health care providers due to less uniformity in billing than traditional healthcare providers. So, for example, while a general practitioner may use the same standardized tests, protocols, and services for the bulk of its patients, a mental health provider deals with a variety of procedures due to different therapy approaches. Now, this issue is even magnified when your staff will have to consider what the insurance company will consider as ‘mainstream’ enough to cover. Even the patient’s willingness to accept and participate in certain treatments will also impact your billing.

Thirdly, Pre-authorization requirements also create stress for healthcare providers. To improve a better patient experience, it is critical for healthcare providers to ensure incorrect pre-authorizations due to initial coding errors do not leave patients with unpaid bills. And with providers like community or not–for–profit clinics or offices running on very tight margins, this creates an even bigger issue.

Lastly, we will talk about pricing, which is an important part of your billing process. Many healthcare providers lose out on revenue by not systematically reviewing their fee schedule and ensuring that it is appropriate based on reimbursement levels. For example, there are some EOBs or ERAs where payers reimburse at 100% of the charge, and if, your fess is too low, you will likely loose out on revenue form one or more payers.

Common Billing Mistakes

Although billing mistakes are common, the main reason behind them is that the provider does not have the right tools or resources to rectify them. This can have overwhelmingly negative consequences for providers, patients, and the payers. Let’s take a look at some of the common billing mistakes:

1. The corrected claims are often missing the original claim number and remark codes for reference.
2. Inconsistency in payer details in the bills can range from outdated records to fraud, and this is one of the biggest reasons for bills getting bounced back.
3. Resubmitted claims have inconsistencies due to remarks not being adequately tracked or revisited on resubmission.
4. Legacy systems often don’t get updated per the latest medical codes.
5. Having the staff member manually enter the code can cause an issue as they may not be familiar with codes.
6. Incorrect use of modifiers to elaborate on services can cause a claim to be rejected.

So, the providers should ensure that the care team members are diligent enough to accurately bill only for the services they provide on specific dates that they are seeing the clients. Also, it is essential to ensure facility-wide education regarding the use of proper, specific codes. The care providers must also find and document the codes that are as particular as possible when creating a formal diagnosis for each patient.

Now the question for healthcare providers is how to bring better accountability and accuracy to their billing processes. So first, it is recommended that care providers identify revenue streams, examine allocations, create project budgets, track funds and manage payables using an integrated accounting platform. For practices that are expanding or serving new clients, it becomes all the more important.

If you are facing a similar type of issue, your Practice Management system is not intuitive enough like Elixir, which helps you avoid claim rejection and denials, and enhances billing accuracy by automatically managing your payables. Powerful reporting tools of Elixir enables you to identify new revenue streams and track their status easily. Elixir also helps you provide a more cost-effective and efficient billing process with bundled billing, where a group of similar services provided by multi-care provider are combined within a specific period and billed together as an episode of care.

Elixir’s Billing system is the one to have. It helps you refine and reach objectives using a cloud-based system with Salesforce.com platform, making it easier to integrate with other systems. This means you can base projections on the actual numbers coming through your practice instead of having to guess based on annual revenue and expenditures. Elixir’s intuitive billing tools help you to efficiently manage your revenue cycle, making your practice more profitable, accountable, and efficient.

Want to see how Elixir can streamline your billing process? Reach out for a demo.