Why Did My Medical Billing Claim Get Denied?

Why Did My Medical Billing Claim Get Denied?

Apr 5, 2021 | Claim Status Inquiry, Claims, Denied Claims, RCM Insight

If a medical billing program has “scrubbing,” why did my medical billing claim still get denied? It is a common question that we are going to answer today.

First, let’s get a better understanding of the words we are talking about.  In the medical billing world, validation and scrubbing tend to be used interchangeably.  While they are similar – they are not actually the same. Understanding what you have and what you need will help you submit ‘clean’ claims.

According to Technopedia, data validation checks for the integrity and validity of data and ensures the data complies with the requirements. So, what requirements? Often people assume that this means payer requirements, but that is typically not standard. Validation rules are built into your practice management software and can be used for several points.  Following are some common rules you may find in your program:

  • Ensure NPI‘s and Tax IDs are the appropriate lengths
  • Ensure patients date of birth is entered
  • Ensure that a procedure code and place of service are present on each claim

 

While these scenarios are standard across the industry, there may be other situations that a validation rule can help. Some programs will allow you to create custom rules for your practice. A customized validation rule will allow you to create a rule for a payer requirement.  For instance, you could create a rule to prevent the following:

  • Do you have a code that always requires a modifier, but only for a specific payer?
  • Work with pediatrics and always need the ‘relationship to insured’ to read something other than self
  • How about insurance ID numbers that are a specific alpha-numeric combo, like 3 letters followed by 9 digits?

 

Keep in mind, if you are creating validation rules the program will make sure that the criteria are met based on the rule entered into your software. When creating custom rules, it is important to note that this will not verify payer billing guidelines. You will need to obtain information directly from your payer to create a rule that coincides with their policies.

Once any validation errors have been addressed your claims will go to the clearinghouse you are working with. Most clearinghouses offer claim scrubbing for an additional fee.  Technopedia defines data scrubbing as the procedure of identifying and then modifying or removing incomplete, incorrect, inaccurately formatted, or repeated data.

 

Claim scrubbing is available in several ways. It may be used within your practice management system, your clearinghouse, or even a third-party vendor. Claim scrubbing services can vary greatly in what they are looking for.

Once the claim has left your practice management system it will likely go through at least 2 scrubbing programs—one with the clearinghouse and one with your payer, prior to accepting the claim for processing. When claims are found to have an error, these results are sent back through a Claim Status Report (ANSI 277 file or a human-readable text file). This report will include information about why the claim cannot be processed. This report will also indicate whether it is the clearinghouse or the payer that is rejecting the claim. If you have further questions about the rejection, you will need to contact the entity that has rejected it.

 

Checking the Claim Status Reports on a regular basis will help you correct the errors and resubmit in a timely manner. In addition, the information you have gathered from the rejections can be used to update internal processes or create customized validation rules to prevent future rejections for the same error–saving you time and money!

RCM Insight is a medical billing company that uses EZClaim’s medical billing software. For any details that have to do with claims validation and “scrubbing,” contact RCM Insight directly.

ABOUT EZCLAIM:
EZClaim is a medical billing and scheduling software company that provides a best-in-class product, with correspondingly exceptional service and support. Combined, they help improve medical billing revenues. To learn more, visit EZClaim’s website, e-mail them, or call them today at 877.650.0904.

[ Contribution by Stephanie Cremean’s with RCM Insights ]

How To Improve Medical Billing Collections

How To Improve Medical Billing Collections

Apr 5, 2021 | BillFlash, collections, Credit Card Processing, Denied Claims

With patient payment responsibility increasing each year, medical practices need to be extra diligent in collecting patient payments. This includes sending accounts to collections when necessary. Fortunately, there are steps you can take to make collections easier and more effective—both of which contribute to more revenue for your practice.

Here are three ways to improve your medical billing collections.

1. Be clear about your payment expectations
Make sure patients know when they will be expected to pay, and what payment methods you accept. Collecting copays before each visit is one of the best ways to avoid having accounts sent to collections, so making payment a part of the check-in process is a good idea. Post signs throughout the office to keep bills top of mind for patients. The more reminders you give patients about their payment responsibility, the less you will have to deal with collections.

2. Reach out to patients who have stopped paying
Keep an eye on delinquent accounts. If an account is approaching 30-60 days past due, it’s time to reach out to the patient. Try to have an empathetic conversation to see what you can do to help them pay off their bill. If they are experiencing financial difficulties, offer to adjust the payment terms to something more suitable to their situation. Even if it means you are only collecting part of their payment now, both the practice and the patient will be better off in the long run.

3. Automate what you can
The collections process is slow and cumbersome—if you’re doing everything manually. Software like BillFlash Integrated Collection Services saves your staff a lot of time by handling the manual processing for you. After that, all you need to do is approve which accounts to send to collections, based on the aging and amounts you prefer, and a collections expert will get to work collecting your revenue.

So, visit one of EZClaim’s partners, BillFlash, to learn more about how BillFlash Integrated Collection services can improve your medical billing collections.

ABOUT EZCLAIM:
As a medical billing expert, EZClaim can help the medical practice improve its revenues since it is a medical billing and scheduling software company. EZClaim provides a best-in-class product, with correspondingly exceptional service and support. Combined, EZClaim helps improve medical billing revenues. To learn more, visit EZClaim’s website, email them, or call them today at 877.650.0904.

[ Contribution from the marketing team at BillFlash ]

Insights from a Medical Billing Expert

Insights from a Medical Billing Expert

Apr 5, 2021 | AMBA National Conference, Medical Billing Software Blog, MMBA Chapter Meetings, Support and Training

In this interview with a medical billing expert and co-owner of Elite Billing Resolutions, Vicky Greenwood, we talk about dealing with the challenges in owning a billing company, some important skills that every medical biller needs, and the value of choosing the right medical billing software. In our time speaking with Vicky, we focused on topics that will aid, contribute, and help grow the skills of the medical billing community. We at EZClaim believe in highlighting the best practices in the industry and sharing those with the larger community. We encourage you to consider these insights, and then let us know what topics you would like to learn more about.

 

EZCLAIM: When did you get into medical billing?
VICKY: “I started in 1994, and at the time we were working on a dinosaur of a system called, “Signature.” We would have to wait overnight to process the entire day’s work. Then we would return in the morning to see if there were any errors in the batch or denials in the claims, which meant being accurate in entering information was essential. Outside of that, we kept all our paperwork in filing cabinets, and they needed to be sorted and organized by date. If a date was off in the filing system it could take the better part of a day to find a patient’s claim. The difference between then and now is night and day. I am definitely thankful for technology.”

EZCLAIM: Why did you start Elite Medical Billing?
VICKY: “We started Elite Medical Billing because we wanted to be able to directly impact our medical practices with the services we provided, and we wanted the freedom to enjoy doing it for our clients. I also knew that I was experienced in the field, was competent at my job, and enjoyed doing what needed to be done to get practices paid. Once I honed those skills and knew we could do it. We hired a lawyer and an accountant, then formed our company.” 

EZCLAIM: What are challenges in starting a company?
VICKY: “First, you have to understand the value of time management and delegation. You don’t want to bite off more than you can chew. It is good to know when you need to ask for help. Next, you want to find good staff. I look for people who have the right attitude about the job first and have the characteristics to be proactive and work hard. Then, I look for experience in the field, learning if they had hands-on experience with claims, denials, and coordination of benefits is part of that. At the end of the day, my staff are my [company], and fortunately, most of my staff have been with me from the beginning.”

EZCLAIM: Why did you choose EZClaim?
VICKY: “We had a client who needed software and, being a smaller company, we needed cost-effective software with strong tech support. When we searched on Google for “easy to use medical billing software,” we found EZClaim. We were won over by the first phone call. Since then, we have been reminded of how great a decision that we made. The simplicity by which you can enter the information, process new patients, and ‘claim them’ within minutes is invaluable. That combined with the great customer service—that answers our questions most often on the first call with detailed answers—and video tutorial support is why we will continue to use and promote the software.”

EZCLAIM: Are you a member of AMBA and MMBA?
VICKY: “We joined the MMBA and AMBA in 2016 to help us certify our billing company. That process and the training, testing, and materials were amazing pieces of helping us get established and grow. In addition, the expos, webinars, and online support offer an abundance of information. Of course, the annual expos are both informative and a great work trip for team building and fun. We make it annually to the MMBA, but our next big goal is to go to the AMBA in Las Vegas!”

EZCLAIM: Have some final thoughts to offer fellow medical billers and business owners?
VICKY: “As a medical biller and owner, you have to be willing to talk with physicians. You need to show them the vouchers and documentation of your work. And it is important to communicate how they bill and how they can be sure to properly classify to get paid. You need to review what they have done in the past and how they can improve in the future by training staff.”

“You can also add value by making them the good guy and yourself the bad guy when dealing with patients and getting paid. We allow patients to call us directly, we answer the questions, and tell them how much they have to pay—then we forward the call to the office. Remember, at the end of the day, you have to show them the money. They work hard and they deserve to get paid.”

ABOUT EZCLAIM:
As a medical billing expert, EZClaim can help the medical practice improve its revenues since it is a medical billing and scheduling software company. EZClaim provides a best-in-class product, with correspondingly exceptional service and support. Combined, EZClaim helps improve medical billing revenues. To learn more, visit EZClaim’s website, email them, or call them today at 877.650.0904.

Medical Bills and the Price Transparency Rule

Medical Bills and the Price Transparency Rule

Mar 10, 2021 | Medical Billing Software Blog, Partner, Waystar

New Patient Survey About Price Transparency Rule

With the cost of insurance premiums and deductibles both on the rise, patients have begun taking on greater responsibility for paying for healthcare than ever before. In return, they are becoming more discerning shoppers and expect more from the patient experience that their providers are delivering. One of the biggest steps that have been taken to create a more standardized, consumer-like experience is the introduction of the final price transparency rule from the Centers for Medicare and Medicaid Services.

More than half of consumers have received an unexpected medical bill

Despite the $3.81 trillion that was spent on healthcare in 2019, America’s healthcare payments system has long remained opaque and broken. Patients are frequently faced with unexpected or surprisingly high medical bills, discover too late that a provider they’d been told was in-network was actually out of network, and are forced to wait 60-90 days to receive their medical bills.

Patients are more concerned about billing than the quality of care

In October 2020, Waystar surveyed 1,000 consumers about their experiences with medical bills, and awareness and attitudes towards the upcoming price transparency rule. More than half of respondents have received an unexpected medical bill, meaning that they assumed a service was covered by insurance and it ultimately was not, or the amount they expected to pay out of pocket was different from the bill they received.

> > > CLICK HERE To Read the Results of the Waystar Survey < < <

 

ABOUT EZCLAIM:

EZClaim is a medical billing and scheduling software company that provides a best-in-class product, with correspondingly exceptional service and support. Combined, they help improve medical billing revenues. To learn more, visit EZClaim’s website, e-mail them, or call them today at 877.650.0904.

[ Article contributed by Waystar ]