Billing Mistakes You Can Prevent
Avoid avoidable billing errors! Brandy Brimhall joins us to unpack simple, preventable mistakes in patient data entry that slow payments, and how getting it right upfront boosts collections fast.
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Transcript:
Marc:
This week, I’ve got Brandy Brimhall, who is the Chief Operating Officer for revenue cycle management for Practisync, which is a wholly owned subsidiary of the Illinois Chiropractic Society. And we’re going to talk about, well, we’ve got a lot of things to talk about, right, Brandy? But we’re going to talk about avoidable errors in billing to ensure greater collections. We were just talking about this a few minutes ago. Talk to us a bit about what you see on a regular basis, some challenges that come across your desk regarding rejections, denials, and all the different reasons why insurance companies don’t pay our doctors.
Brandy:
Absolutely, so we all know that there are things we can control and things we can’t control, right? So I always like to look at the things that we can control on our side, which is identifying and removing those interferences that impact our revenue cycle system. So the things, as far as rejections, denials, and all of you know, end to end with the revenue cycle that are impacting our doctors, really, from one end to the other, has to do with making sure our patient accounts are set up properly, making sure that we are inputting the correct insurance payer so our claims are being routed properly.
One of the common challenges that we have is the Medicare patient, for example, hands us multiple cards. We bill Medicare, not realizing that there’s Medicare Advantage in one of those cards, and so we’re billing the wrong payer. That’s one example of many. Another one is using an invalid diagnosis. So remember, in our diagnosis training some years back, we had those excludes one the diagnosis that aren’t allowed to be used together on the same claim. We run into quite a bit of those. There’s also just not being familiar with our payers and what the parameters or the patient coverage is, which means we perhaps could be billing for charges that we were required prior authorization, didn’t obtain the prior authorization.
Remember, every patient gets a copy of those remittances that we get to when it tells the patient you may be billed zero because the clinic failed to obtain pre-approval or pre-authorization for your services. Another item simply could be that we’re not going through and managing and looking at our rejections and making sure that those rejections that are common, such as misuse or misapplication of our modifiers, misuse of procedure codes that aren’t allowed to be on individual claims for particular payers that we’re not familiar with, the payer coding guidelines, in other words, for some of the payers that we’re submitting. So end-to-end, that’s a very general summary, in a nutshell, of what takes place in those challenges that we’re having. But the good news is they’re all controllable. They’re all interferences that we can identify. We can follow them upstream and either remove them entirely or minimize them, which ultimately makes us more streamlined and efficient. End-to-end, with our revenue cycle system, which means the docs are getting paid faster.
Marc:
Yeah, so let’s, let’s narrow it down, because that’s a lot to unpack in there. In fact, there are probably four videos, five videos just on that. So let’s unpack maybe the first one. And it seems super benign, but let’s talk about making sure that the patient’s information is accurately put into the system right out of the gate. Again, it seems like, well, no duh, Marc, but at the same time, it is common. So what types of things do you see in that area?
Brandy:
Yep, absolutely. I love to follow everything up and down the stream, wherever those interferences are, and certainly at the top of the stream is making sure our patient accounts are set up properly. So, a few of the things that we commonly run into are the patient’s name as it appears on their insurance card. Isn’t the name they go by some other nickname or middle name that is commonly known to them and what they’re referred to. So if those names don’t match, that can cause problems with rejections and denials. Another common challenge is that we have a parent and a child, so we have an insured and then an insured beneficiary, and the child is the patient, but the payer requires the insured’s information on the claim. If we don’t collect that and have that on file, then what happens is we have to go back and reach out to the patient to get that information. We’ve all done it before, and we know that we can call for days, weeks, or months and not receive a return call, which means that claim can’t move. That claim is aging, moving toward timely filing. So that’s another challenge we often have, for some reason, missing demographics. So, patient’s date of birth, patient’s address, patient’s zip code, things along those lines. Another very common one is just transposed characters or digits in the patient’s policy number, that causes those claims to be rejected and the patient not being identified. So really, it’s all just attention to detail from one end to the other. But those are certainly some common errors that are certainly avoidable or at least able to be minimized, that really help a lot in the revenue cycle system.
Marc:
Yeah. So let’s just touch on a couple of things in there. Two of them, let’s hit one is the name, and it sounds like, Well, yeah, of course, that’s true, but I’ll use me as a great example. I go by my middle name, and so I’ll even write on my forms when I give them to the doctors, a lot of times, I’ll just put Marc Abla, and that’s what goes on the forms. But in the end, what ultimately happens is, because all of my insurance information is under my first name, I’ve actually had rejection. So I’ll have doctor’s offices give me a call and say, Hey, this you know, it’s getting rejected. It’s saying that you don’t have coverage or that the information isn’t aligned. So it’s very important to make sure you get a copy of the insurance card and verify what you’re putting in. I know you want to call your patients what they want to be called. You want to call them by their nickname. Make sure you know, use a nickname field if it’s available in your EHR system, or in your billing software, whatever it may be, whatever you’re going to be referencing, yeah, you can include that. But when we start talking about what you’re submitting on that claim form, make sure that you’re using that legal name or the name that’s attached to their insurance. You might even find this with people who are going through changes in maybe marriage or divorce, where they’ve given you a different name, and that’s what they want to be called. But until that’s legally changed, or until that changes with the insurer, make sure that you have the right names in there. I think that’s an easy one to improve on upstream to increase the speed, and I think you touched on this, too. Patients don’t love to get back to you when you start talking about collecting money from them, so they’re not in any hurry, and so it’s better to get it right up front.
Brandy:
Absolutely, I completely agree, it helps a lot with the billers. Helps a lot with collections. Anyone who’s having to navigate and manage AR monitor those timely filing guidelines for all of our payers. Certainly helps to minimize all of those downstream issues that we run into just by paying attention to detail upstream.
Marc:
Yeah, and we’re, you know, everybody’s super busy. We know that your front office staff, your reception staff, they’re busy. Those, those team members of yours, are incredibly busy. But it’s worth taking that extra moment to double-check, make sure the numbers haven’t been transposed. There’s a reason why, when you change your password anywhere, you have to enter your new password twice, because they want to verify that it matches. In those cases, this is one of those that, if you could do that, that would be a great system to put in place. But at the very, very minimum, you want to make sure that you verify that the numbers are accurate, that the names are accurate inside of your billing software.
Brandy:
Absolutely, it’s one of those tasks that we can become so easily robotic and just entering the information and moving on, which makes it easy to make mistakes. And so, just doing our due diligence, double checking definitely a good step.
Marc:
Get it right, and hopefully this helps you out, gets you paid faster, more, and we’ll catch you next week.
