Unpaid claims are a huge drain on your bottom line. And nobody wants to miss out on money earned. Follow these simple tips to keep your rejected and denied claims ratio in the healthy range. [See related post: 5 Billing Vital Signs You Should Be Checking]
#1 Collect and Check Patient Insurance
If there’s only one thing you remember from Billing 101, it should be this: a patient must have active insurance. Best practice is to collect insurance information and verify benefits — every patient, every time. Don’t forget to verify eligibility for the date of service. And, always obtain an authorization for services rendered, including testing and any procedures to be completed.
#2 Know Your Modifiers and When to Use them
Don’t give insurance carriers a reason to deny your claims. Use the correct modifier(s)! For example, if a patient is in the cataract surgery post-op period and they’re then seen for an unrelated issue like dry eyes, the exam for dry eye requires a -24 modifier. Or, if you’re billing for punctum plugs, bill 68761 -50 for a bilateral procedure or 68761 -E1, -E2, -E3, or -E4 for all four lids, depending on which carrier is being billed.
#3 Choose The Correct Diagnosis Code
Keep in mind that insurance carriers will only pay for claims they consider medically necessary. It’s important to make sure that the diagnosis codes on the insurance claim are appropriate for the services rendered. For example, a patient presents with dry eyes and an exam and OCT is performed. The OCT is likely to be denied because insurance carriers don’t consider performing an OCT for dry eyes to be medically necessary.
While billing isn’t quite as simple as 1-2-3, these three tips will help you get your claims paid quickly and completely.