Insurance claim denials aren’t just a headache.

For many practices, they can pose an ongoing problem that inhibits cash flow through your practice–and leaves you struggling to pay the bills. Not only that, patients can become frustrated if they receive bills for services that they assumed were covered by their insurance–and that, in many cases, they may not have the funds to pay out of pocket. Are you tired of dealing with insurance claim denials? Do you want to get paid faster? Do you want to reduce claim denials? Your EHR system should help, not hinder, the claims process. Using an EHR system like Procentive, which has built-in reminders that help let you know when a claim is unfinished or needs attention, can help you decrease the number of insurance claim denials.

To reduce claim denials, you must first know how to calculate your claim denial rate.

BEST PRACTICES FOR INSURANCE CLAIM SUBMISSION

STEP ONE: MINIMIZE HUMAN ERROR

Millions of healthcare insurance claims are denied each year. All too often, those denials come, not because the services aren’t covered by the patient’s insurance, but because of human error somewhere along the way. These steps can help increase the odds that your claims will be approved.

Always confirm the patient’s insurance at the beginning of each appointment. Check the number in the system and make sure that it’s listed correctly while looking at the card or patient information, rather than waiting until a claim is denied to double-check that information. This is particularly important at the beginning of the year, when many companies change insurance providers or policies, but you should check with your patients any time they come into the office to make sure that their insurance hasn’t changed.

Double-check all billing codes. The difference in a single number can be enough for an insurance company to deny a claim, leaving your patients without the coverage they expect from their insurance company. Always double-check your billing codes before submission to ensure that the claim moves as seamlessly as possible. Using a former version of those billing codes can also trigger a claim denial, so it’s particularly important to ensure that everyone in your office remains updated on the latest codes.

Always make sure patient billing information is accurate and complete. In order to file an insurance claim, you may need the patient’s full name (spelled correctly), date of birth, and other personal details, including the social security number of the primary policy holder. If any of that information is missing or inaccurate, the insurance company may deny the patient’s claim. You should also carefully qualify the primary policy holder on the account to ensure that the claim is properly filed.

Utilize the checklists below to ensure that all of these items are properly covered in your office– and that your billing specialists don’t miss any important details when filing a patient’s claim. Efficient EHR software can also help double-check that information, identify inaccuracies, and ensure that you have the correct information in place before you send that claim to the insurance company.

STEP TWO: CHECK IN WITH AND TRAIN STAFF

When you hired your staff, you likely made sure that they had a solid understanding on code updates and procedures for your office. Over time, however, those codes and procedures may change substantially. Procentive offers biller refresher training that can help you and your employees learn how to use the system more effectively, including ensuring that every member of the team knows how to properly code and manage patient bills.

Hold or require annual training and updates. Ensuring that your staff receives training each year is the best way to keep behavioral health codes and your office policies fresh in their minds. When employees see that information regularly, they’ll be more likely to retain that information, including information about things they don’t deal with as part of their daily responsibilities. Annual training is also a great time to go over new office policies or changes in healthcare coding and billing regulations. This refresher training, like what is offered by Procentive, may include elements like:

• How to handle reports
• Collections
• How to properly schedule appointments
• How to properly code requests
• How your electronic systems work

Update all members of staff when you institute a software or policy change. Don’t just update the top members of your staff and assume that it will trickle down. If you’re instituting new policies or using new software, make sure every member of the team is properly trained in how to use it. Training can also help answer key questions about changes before your staff has to actively deal with those responsibilities.

Check in before there’s a problem. You don’t want to wait until you’re bogged down with insurance claim denials, leaving your behavioral health practice with substantial cash flow problems, before you check in with your employees. While you certainly want to talk to employees any time a clear problem arises, you should also institute regular check-ins that will allow you to keep up with how your employees are handling those challenges, answer any questions they may have, and provide them with a reminder of any office policies.

DO YOU NEED TO IMPROVE STAFF TRAINING?

If you’ve fallen behind on your staff training, there are several signs you may notice. If you note any of these symptoms in your practice, you may need to update your training policies or procedures.

• You’re seeing a lot more insurance claim denials than usual, potentially for no apparent reason.
• There’s one specific person in your office that everyone goes to with questions–and that person barely has time to complete their own work due to the frequent influx of questions.
• There’s been a recent coding update.
• You’ve recently instituted new policies for coding or patient interactions.
• You have recently chosen new billing software.
• You haven’t had training in quite some time.
• Staff members have increasing questions about certain policies or procedures, or you’ve noticed that staff members are confused about an element of your software or policies.

STEP THREE: KNOW WHAT PATIENTS’ POLICIES COVER

In order to reduce patient claim denials, you need to know what their policies cover–often before rendering services. Patients also need to know what their insurance will and will not cover, especially since that can determine which services they choose to pursue and which ones they forego until they have vitally-needed funds in place. Ask these questions:

What specific procedures or treatments will patients’ policies cover? Some policies, for example, may allow patients only a specific number of appointments with a mental health professional each year. Other policies may have strict guidelines on the type of mental health professional they can visit.

How much coverage does each patient have? You may need to know exactly what the insurance company will cover before submitting that bill so that patients can take care of their financial responsibilities sooner and more easily. Patients may also need to be able to determine how much insurance will cover at any given point in treatment so that they can make plans to cover those bills.

What is the patient’s responsibility when it comes to payment? Most patients will have some copay for their treatments. They may also need to meet an annual deductible before their insurance kicks in. Make sure you have a solid understanding of what obligations the patient will have so that you can bill the patient appropriately.
In addition to helping you track the coverage offered by patients’ policies, EHR software like Procentive can help track patients’ financial responsibilities and keep up with their deductibles and other financial obligations. It can also help track the bills you’ve sent to help avoid double- billing and ensure that patients aren’t billed unfairly.

DECREASING CLAIM DENIALS: A CHECKLIST

If you’re ready to reduce patient claim denials in your office, you need to accomplish these tasks.

• Use our checklist to ensure that patients’ claims are submitted properly. Include all the information necessary to submit an insurance claim while reducing human error as much as possible.
• Make sure you double check what patients’ policies cover before submitting insurance claims. Always use accurate coding and billing. Do not misrepresent the services received by a patient.
• Train your employees annually, and offer additional training when needed to help your employees keep up with the latest changes in billing, coding, and patient care.
• Utilize effective EHR software that double-checks for errors and helps streamline the billing process, keeping your insurance claims more accurate and offering a better experience for your patients.

Your Insurance Claim Checklist

Your insurance claim checklist may include insuring accuracy of:

• Patient’s insurance, including policy numbers
• The primary policy holder for the patient’s insurance
• The patient’s full name, including correct spelling. Double check names with multiple possible spellings or patients with unique or unfamiliar names!
• The patient’s date of birth
• The policy holder’s social security number
• The patient’s gender as listed on their insurance information
• Billing codes for any procedures or treatment the patient received