There’s a lot going on in your practice, right? The patient walks in and the work begins, they give you their old insurance card, then say that the number is different now and produce an image of their current card, which they “left at home”, on their phone. Then they ask if it’s going to be much longer, although they’ve only been in the reception, filling out documents for four minutes. Then, they decide they need to run to the bathroom. Your team points them in the direction of the “good bathroom”, because that other one is always out of order. Then you also expect your amazing staff to do all of the motions to get your billing done? While they probably could do it, why would you want them stressed and coming apart come time to deal with your patients? There’s a simplicity to keeping your team calm cool and collected, and leaving your revenue cycle management up to the billing professionals on our Gables Medical Billing team. We help your practice avoid even the most common errors, like the ones below:
We begin helping you avoid the common issue of upcoding, which is when the patient’s diagnosis is inflated to a more “serious” or “complicated” prognosis. This sort of error would also apply if a clerical error occurred, or if the service or procedure is not covered, but is substituted with a covered procedure. On the other side of billing complications, there is also unbundling, which means that separate billing codes are being used for what should be billed using only one code. Another issue that is seen commonly is that a patient is charged for the same procedure more than once, this is referred to as duplicate billing. Wrongful billing is another issue where a practice’s revenue cycle management is placed in a compromised position. This occurs when a patient is charged for a procedure that was never performed, or was scheduled and later canceled, but never taken off of their medical record. There’s also the famous EOB, or explanation of benefits. Which, quite simply, can be so confusing. Patients have paid their co-pay and then you get a letter letting you know that they did that, what their insurer is covering, and the explanation of why, or why not, you’re receiving your expected payment. This will also let you know if the claim was denied, the reason for denial if you need to resubmit and the expected parameters for resubmission.
At Gables Medical Billing, we have no doubt that your practice is busy and your staff should be the pleasant and ever-present guidance your patient needs to get ready for their visit. Let our team assist you in submitting clean claims, getting reimbursed, and handling the small details that could frustrate your team and lead your patients to think about their options
