Frustrated with not getting paid for the work you do?
Well, I have a deal to make with you. If you are willing to take a few moments to review some office procedures in your practice, I can guarantee you will find a few ways you can improve operations and help things move forward smoother.
Pay close enough attention and you will see a few trends begin to emerge. Trends on WHY those claims are being denied. In my experience, there are five basic avoidable problems that stand in the way of getting your private practice claims reimbursed.
Take a look and let me know which one sums up the problems you may have had:
It’s the little things that count when it comes to gathering the right information to bill for mental health services. Correct demographics, policy information and even insurance company information is essential to making sure your claim is attached to the right person, the right policy and going to the right place. Any discrepancies here and those claims are getting denied.
The good news. It’s a denial that you can correct. If the claim comes back denied, update the information correctly and resubmit and your claim should be processed with no problem.
My goal is to save you the frustration and headache of having to manage the denial at all. Instead, set up a solid intake process that starts with making sure you know the right questions to ask new clients and double checking to be sure you have accurate answers.
Just because your client was eligible for services at the beginning of your work together doesn’t mean that they will continue to be eligible a few months down the line. There are tons of life events that can change someone’s health insurance. New employer, lapse of payment, annual renewals, employer changing insurance plans…on and on. We cannot rely on our clients to know when they need to update us. They may not understand that those changes may require attention on your part so that claims are not denied.
I recommend that you verify eligibility before every visit. Some practice management systems are able to do this with the click of a button, other times you may have to quickly visit the insurance companies website to check eligibility. Trust me, it is WORTH it to do this ahead of time and not have to manage denials on the other side.
Some insurance policies are going to require that you have an authorization in place in order to bill for services. This means going online or calling ahead of time to request that authorization to ensure that you will receive reimbursement.
But that is just the start…after you set up the authorization, you have to track it. Let’s say you are given 20 visits with a six month time frame…you will need to make note of how many visits you are using and how much time has passed so that you don’t run out of authorized sessions and continue providing services. Good News…most practice management systems will provide you with a simple and easy way to track your efforts. Be sure to inquire with your practice management customer service to make sure they tell you how to properly track your authorizations. One other word of advice on this one, create a pattern of requesting a new authorization when you have about 4-6 remaining. It makes it easier to keep things flowing with out the stress.
Billing errors cover a pretty wide category and the truth is, they happen from time to time…even in practices that are running fairly smooth. It could be something as simple as not knowing exactly where to send the claim to accidentally submitting a duplicate claim or entering a code in incorrectly. Sometimes a more complex issue like coordination of benefits might come up and you have to navigate billing to a secondary insurance. Generally…all of these are solvable problems, something that can be fixed once you understand what has to happen.
I see this one often when people are new to private practice. Maybe they start seeing clients before they have the billing solution in place. Without a clean way to submit the claims…they wait…and wait…until they have waited so long they run into something called Timely Filing. Timely filing means there is a window of time where an insurance company will accept a claim for payment. After that, they are going to deny your claim simply because you took too long to submit it! Wow…this is SOO avoidable. Don’t let this one happen to you. Before seeing clients, think through how you are going to submit those claims. Don’t let them sit unprocessed for 6 months or more.
Listen…I know it is tempting to opt out of something when we don’t get the results we want. But with a few infrastructure updates, most of the problems private practices are having with insurance companies can be solved. Do yourself and your clients the favor of building solid systems in your practice.
I feel saddened when I see that people have had such a frustrating experience and I know that it doesn't have to be that way.
If you are struggling to get paid for your work or feeling overwhelmed…get the mentoring you need to build the practice you want. Find out about our Practice Pro Mentoring Program and how it can help you make your pro-insurance practice one that is business savvy and set up for success!