Correct insurance claims filing to insurance companies in todays world is crucial to the healthcare provider. We have listed the 10 top billing errors that can cause a claim to be rejected or delayed. 1. Duplicate Claim If you are filing a claim for the second time, indicate in a letter that this is not a duplicate but a second request for payment. 2. Beneficiary Eligibility Call and verify with the insurance carrier that the patient is indeed covered by the insurance company the patient presented to you. 3. Incorrect Carrier Make sure you send the claim to the correct carrier. Some insurance companies have multiple addresses to send claims to. Make sure you have the correct address. 4. Procedure code/Modifier invalid CPT codes and modifiers change every year. Make sure you are using a code that is still valid for the date of service you are billing for. 5. CLIA This is a number that is required for claims filed for medical doctors. Without it, your claim can be denied or delayed. 6. Bundled Services Some carriers bundle codes to allow less payment. If you feel the code should not be bundled with another code, use the appropriate modifier to indicate a separate procedure performed. 7. Medical Necessity If a carrier determines the services were not medically necessary, be prepared to appeal the claim with notes and case history for the procedure performed. 8. Non-Covered Services When verifying benefits, always ask specifically if your procedures you are about to perform are a covered item. This will save you a lot of time if you know ahead of time. 9. Medicare Secondary Payer (MSP) All Medicare Primary has to be filed and responded to prior to filing with the Secondary Payer. The Explanation of Benefits or Payment from Medicare, must be attached to the Secondary claim for payment to be considered. 10. Provider Eligibility In almost all cases, the Provider must be participating (In Network) with the carrier in order to receive payment. In some cases, Out of Network benefits are available, but the Provider still must be registered with the carrier in some form. Submitting "clean" claims to the carrier will ensure prompt payment in most cases. Claims should be carefully audited before being submitted to the carrier if the provider wants a timely payment. When readily available, send notes with the claim to justify services. |
