Insurance billing is never anyone’s favorite aspect of running a private practice, but is a necessary part of the process. The start of a new year is the perfect time to brush up on your know-how so that you can put your practice in the best position to thrive this year. Staying fresh in your understanding of the entire insurance claim submission cycle will help you to keep on top of your practice’s billing and avoid unnecessary delays in cash flow. We’ve put together a list of things to bear in mind as you begin a new year of insurance billing so that you can set your practice up for billing success.
Get Clear on Your Claim Submission Process
The beginning of the year is a fantastic time to review your claim submission system and make sure you have everything in place to complete the insurance billing cycle. Your claims either need to be sent on a CMS 1500 form in the mail or electronically through the insurance company’s website or through your EHR system.
If you are submitting via paper, you will need to obtain the proper claims mailing address for the insurance companies that you bill. If you are submitting through your EHR, you will need to have the correct insurance payer IDs so that your submitted claims are routed to the correct payer destination. You will also need to be set up with a clearinghouse compatible with your EHR system.
Make Sure Client Information is Up to Date
Inaccurate client demographic and insurance information lead to claim rejections, so it is important to make sure that all your client information is current. The new year is the perfect time to update the information you have on file for your clients, especially because insurance plan information changes occur most often at the beginning of the calendar year.
Reach out to your clients via email or in person to verify their demographic and insurance information. Make sure the address you have on file is up to date for each client. If the client has new insurance, be sure to verify the client’s insurance eligibility and determine the client’s insurance status and coverage.
This is also a good opportunity to find out your client’s deductible, copay, and/or co-insurance with the new insurance. Make a copy of the client’s new insurance card, in case you need to review the information provided on the card in the future.
Avoid Common Billing Errors
There are a few simple mistakes that are easy to make when submitting claims, but they can also be easily avoided with a little extra diligence. First, double check your information for typos. Insurance companies can reject a claim with a misspelled name or incorrect date of birth. Make sure your client’s demographic information and insurance information is spelled correctly and free of any transposed number errors.
Duplicate claim submission is another common reason for claim rejection. Duplicated claims tend to happen if multiple staff members in the same office both file the same claim. These duplicated claims will likely come back rejected by the insurance company. You can avoid this hassle by ensuring that claim submission responsibilities are clearly defined and delegated in your office.
Incorrect coding is a very simple mistake that can lead to rejected claims. Be sure to stay current on the most valid CPT, ICD-10, and DSM 5 codes and review the coding on your claims before you submit. You can reduce your volume of rejected claims by being vigilant and accurate with your coding.
Be Timely in Your Claim Submission and Follow Up
Timely claim submission and follow up are tickets to billing success. Most insurance companies require claims to be submitted within a 90 window, so it is important that you submit your claims within 90 days of the rendered service date.
If claims go unpaid for over 30 days after the date of submission, it is a good idea to follow up on those claims with the insurance company. It is possible that your claim was routed to the wrong location or was never received by the insurance company. Following up on these claims after 30 days will help to keep you on top of any potential billing snafus.