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The Five Most Common Billing Mistakes
Moderator(s): Acuclaims *, Jane Yu
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3/11/2012 at 10:59:40 PM GMT
Posts: 2
The Five Most Common Billing Mistakes
Hiyas, what are the common mistakes that people make when trying to get paid by insurance companies?

3/12/2012 at 3:59:49 PM GMT
Posts: 10
#1 - By FAR the biggest mistake people make is NOT verifing the patient's benefits.  This is the important 1st step. What's the point of submitting a claim if you are not 100% positive you are going to be paid.
#2 - Not documenting the above verification - who you spoke to and  reference number for the phone call.
#3 - Not understanding coding.  Acupuncture is timed based.  Alot of practicioners only use the 1st 15 min code for everything.
#4 - Sending a bill to the WRONG location.  Alot of practitioners don't understand about Blue Cross/Blue Shield.  The patient's plan might originate OUT of state, but you send the claims to your local.
#5 - Not having a good system for following up on claims.  A good 10-20% of claims for acupuncture are processed incorrectly.  By not having a system to track your outstanding claims you leave money on the table.

3/12/2012 at 9:46:33 PM GMT
Posts: 2
Regarding not getting one's benefits verified prior to treatment, how do you propose that happen in a solo-practice. While they're sitting in the waiting room? After they've filled out their intake information?

Sometimes, I would stick some needles in, and then find out about the insurance. Doing anything else seems a little self-serving and not patient-friendly.

Seems like half the time, even though there is verification on the phone, the payment never happens. Not sure that's something that can be easily remedied with a quick answer, though.

3/14/2012 at 4:50:50 AM GMT
Posts: 10
Do you have alot of walk-in patients?  (Most acupuncturists don't.)  Usually a new patient will call and book either the next day or so.  During that appointment you can take the information you need to verify the benefits.  It's an easy thing to do and vital.  If you are going to offer to submit an insurance claim, you must know that the claim WILL be processed and paid, and a proper verification, done with a phone call, and documented is the only way to know about your patient's benefits.

Now if you say you do that, and still aren't getting paid...  10-15% of the time, the insurance company makes mistakes. However those can get reprocessed and paid.  IF your percentage is higher than that, well frankly you aren't verifying properly.  You are not confirming the diagnosis - acupuncture benefits are VERY diagnosis specific  Now are your claims getting denied OR ignored?  Denied- if it's that 10-15% with proper verification, you send back and have them reprocessed.  Never hear anything back?  You aren't sending it to the right place.  You need to investigate WHAT exactly is happening to the claims you submit.  When done properly, ALL claims should be processed, and either applied to the patient's deductible or paid.  And it isn't rocket science, it just requires a little investigating on the front end.

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