Practices' revenue declines are often a result of billing errors, according to Fi-Med Co-founder and CEO Adrian Velasquez.
With an average cost of $6.50 to file a claim, $25 to resubmit a rejected claim and $37 to correct and resubmit a denied claim, billing errors can add up. Here are the tips Mr. Velasquez shared with Modern Medicine on avoiding those unnecessary costs.
1. Keep up on frequently changing codes. The transition to ICD-10 added 55,000 codes and new complexities, Mr. Velasquez said, and diagnosis codes change every year.
To stay abreast of changes, physicians should either have a certified coder on staff or outsource coding. He said it's also important to ensure the "physician's documentation supports the codes used in the treatment of service" — payers often cite lack of documentation support as a reason for denying claims.
2. Add data analytics. Billing-related data analytics helps physicians determine areas of revenue loss and proactively deal with those issues. Some EHRs and practice management software embeds analytics processes, but additional customization can thoroughly analyze denials. Mr. Velasquez prefers tools that group denials together, which illuminates patterns to correct.
3. Fix common denial problems. Easily fixed denials include ones regarding improper provider credentialing and correct patient information. Someone should conduct an automatic eligibility verification to identify patient benefits and the deductibles remaining when a patient enters the practice. "If you don't do this on the front end, you will probably not get the payment on the back end," Mr. Velasquez said.
Administrative staff should also send claims as close to the date of service as possible.
4. Don't chase payments. Research shows patients who don't pay bills after the first statement aren't likely to pay after two, four or more bills, according to Mr. Velasquez.
"You really need to cut your losses and do a cost accounting analysis of all your payers and their reimbursements, as well as a cost analysis of your procedure codes, in terms of where do you lose money," he said.