Medical billing is critical to the financial health of your practice, as billing errors can have severe consequences. However, there are ways to reduce billing errors. Read along to find out how!

Medical billing is very important to any independent physician’s medical practice as it is the backbone of the financial health of that practice. Often, when errors are made in billing, there will be a loss of revenue, and even beyond that, there may be some serious consequences. For example, if errors in Medicare and Medicaid billing are due to negligence or an intentional attempt to cheat the system, it can result in the practice being suspended from billing those entities for several years.

So, what can physicians do to minimize their rate of making medical billing errors?

Verify eligibility during every appointment: WCH works in medical billing and collection for almost 20 years. We do analysis and see that the biggest volume of denials and resubmissions is related to improper eligibility and benefits verification. Avoid claims submission to erroneous payers. Ensure the verification is being performed during every appointment.  Ensure your office staff is well educated on the proper process (e.g., make a copy of all insurance ID cards, keep proof of eligibility verification, provide biller with updates in a timely manner, use technology, etc.) 

WCH was running separate webinars describing the proper process of eligibility and benefits verification for different specialties.

Let us know if you need such training. In the case of demand, we will renew the webinar series.

Obtain Prior Authorization when required: WCH was also running separate webinars to describe proper authorization management. This process requires special and constant attention as well as technology for process automation.  In few words, it includes: obtaining a new authorization, making sure the obtained approval has not been exhausted and matches the services performed, ensuring your biller has a copy of the authorization, and proof of verification is on file, etc. 

Make sure that all data is correct: A denial will result if the patient, provider, insurance, or other information is missing or wrongly entered. Always confirm the accuracy and completeness of data before submission.

Use technology:  WCH integrates features in the iSmart electronic health record (EHR) system to automatically prevent errors in superbills before submission. The E-Superbill option reduces not only billing errors but also saves valuable provider’s time.  The feature is available for all WCH Billing clients free of charge. Read more here

Keep clinical staff informed: Healthcare practices should carry out consistent training about healthcare updates to keep them up to date with the current regulations and requirements.

Communicate to your biller: The biller helps you identify patterns for claim errors, denials, or delays and how to avoid such cases in the future. Here at WCH, we knowThe Power of Communication in Medical Billing.

Insufficient documentation: Improper documentation will result in coding and billing errors. It may drastically affect the well-being of the practice, a loss of revenue, and beyond that, there may be some other severe consequences.

Billing Inaccuracies around the Place of Service and Medical Drug Dosage Administered vs. Units Billed:

There is some confusion around the rules, and in our November Newsletter, we published guidelines on correct Place of Service reporting for different types of services.

For drug administration claims, the units must correspond to the dosage assigned in the HCPCS code description and the volume administered to the patient, as well as any properly-discharged wastage.

Also, make sure your biller has the accurate National Drug Code (NDC), as almost all payers require the NDC code to be submitted on claims.

Monitor your practice’s financial health

If you want your practice to attain and remain in good condition, you need to perform periodic financial health audits. The vital factors that must be monitored include the following:

Clean claims rate: the percentage of accurately and timely reimbursed claims by insurances on the first submission. The higher that rate – the better other parameters will be. 

Accounts Receivables:  the number of days the claims are outstanding as well as the percentage of not paid claims. Claim rejections and denials, incorrect coding, credentialing issues are some factors that may  affect accounts receivables.

Average Collections per Visit: Amount of money generated from each encounter.

Claim Lags: The number of days between the date of service and the date the charge is submitted. To receive timely reimbursement and avoid any filing denials, we encourage providers to submit all superbills (for processing with full and accurate information) within 30 days after the service date. For Workers Compensation and No-fault payers, the complete package should be submitted the latest within a week.

Monitor Your Claims Performance with iSmart EHR’s Dashboard.  iSmart EHR Dashboard is available for every WCH Billing Client and shows vital information within seconds after logging into the system!

WCH is here to help.

Let the professionals evaluate your coding, billing, and documentation practices!

WCH Service Bureau, Inc. has the knowledge and experience, from medical billing, auditing and credentialing to software development, and everything in between. We are the whole package. We help you to have peace of mind knowing that your practice remains successful and well kept. Our professional affiliations, quality of service, and customer care are what differentiate us from other companies. As a result, we are your trusted adviser, completely focused on your success.