As a private practice Owner/CEO, ask yourself: What is the extent of your expertise in the field of Billing? Let’s face it, we were not trained in Billing practices, coding, etc. We’re not accountants.
So let’s begin by discussing the 5 most common mistakes and problems that owners encounter in their clinic’s Billing – and how to avoid them!
(Pro tip: most of these mistakes start at the front desk!)
1. Incomplete or incorrect patient information
This could be anything from a typo in the ID # or a missing date of birth. Another common one we see is a missing referring physician for Medicare patients. These may seem like little mistakes, but they can be costly for your practice. Incorrect patient information leads to denials and delays on payment.
2. Billing the wrong insurance
Part of the benefit verification process should be verifying where claims need to be sent.
If you have a copy of the card, you can always look on the back of the card for more information. However, payers like Blue Cross Blue Shield always need to be sent to the local BCBS plan even if the patient has an out-of-state policy.
Also, many major insurance carriers have third-party administrators that handle claims processing, so claims need to be sent directly to these third-parties in order to receive payment. Sending the claims to the wrong carrier could lead to incorrect processing or denials which delay the payment for services.
3. Lack of authorization for services
Benefits need to be verified – and verified correctly – before services are rendered.
Soooo many clinics lose out on money because they fail to obtain authorization for services. A lot of payers, like UHC & Anthem, only allow you to backdate an authorization a certain number of days, and if you miss that short window, your services will be denied and not paid.
Once these services are denied, you cannot bill the patient for them.
4. Duplicate Billing (This happens frequently!)
Here, no information is received back from the payer regarding a claim, so billers think they can just rebill it again, rather than following up on the status.
You should always call and verify if the claim has been received and why there has been no payment made. If there is something that needs to be corrected, the payer needs to verify if a clean claim can be submitted, or a corrected claim with resubmission code 7 needs to be billed.
5. Lack of Modifiers
Common ones missed are GP modifiers and/or the 59 modifier. A good physical therapy biller will know when and where to add these modifiers for claims.
Even more relevant now are the Telehealth modifiers: the billers should be aware of what modifier each payer is wanting to process – and pay Telehealth claims correctly. Your billing software should also have the capabilities to customize modifiers according to insurance.
Additional potential issues include:
• Incorrect Codes used
Thankfully, many of the codes are universal; but there are quite a few that are unique to particular insurance companies.
Confusing CPT codes with ICD-9-CM codes and PoS codes can easily cause a denial. Failing to enter the correct number of digits or using the wrong format are among the most common PT billing mistakes.
If you forget to enter all the codes for all the treatments and services provided, or if you use mismatching treatments and diagnosis codes, you’re sure to land in the denial boat. Avoiding this requires having people who are always on top of the quirks and details of PT insurance.
• Overbilling (over-using charges)
Overbilling can be due to a simple clerical error, but charging too much or charging for services not provided can have a very negative impact on the loyalty of your practice’s clientele.
Nonetheless, it happens. Quite frequently too.
Avoiding these PT Billing mistakes requires having a team of people who are knowledgeable, skilled, up-to-date at all times, and working together like a smooth machine.
There is a huge amount of detail to keep track of. At MEG, we recognize from experience that sometimes it can become too much for a practice’s valiant and dedicated admin staff to handle entirely.
Don’t require your staff to perform functions that they weren’t trained in. Consider out-sourcing to professional PT Billers!