Keep Your Medical Practice Open by Avoiding These Major Mistakes
As claims resolution specialists we see medical care facilities and doctor’s offices making a lot of mistakes which threaten their practices. Helping doctors rectify these mistakes is one of the services we provide to our customers.
Many of these mistakes are quite complex. Others are simple issues which the average practice can address right away. Here are four of the simplest ways you can ensure your practice continues to remain financially viable.
1. Never allow yourself to forget your medical practice is a business.
Most doctors get into health care because they want to serve others. Healing is a noble profession, and doctors in general tend to have a great deal of compassion.
Unfortunately, nobility and compassion can threaten a medical practice when they are misapplied. We’ve seen doctors worrying about patient bills to the point where they are refunding patient co-pays after the insurance company cuts a check, which is a form of insurance fraud. We’ve also seen doctors shy away from using medical collections agencies to recoup the patient portion of bills.
You must get paid if your practice is to survive, which means you must do everything you can to recover the money you are owed from all sources. If you can’t turn a profit your practice will not be around next year to offer help and healing to the next patient who comes along.
2. Make sure you are getting copies of patient ID cards and insurance cards.
Member numbers are usually 13-15 characters long and contain both numbers and letters. Transcription errors happen, no matter how careful staff members are about typing these numbers correctly.
What’s the easiest claim for an insurance company to deny? Why, “We can’t find that member number,” of course. An insurance company doesn’t even have to worry about PR problems if they can deny a claim by pretending they don’t know that patient is their customer. Keeping copies gives the staff something to go back to so this common billing issue can be resolved very quickly.
People change insurance policies all the time, so make sure your intake staff is routinely asking if there have been any changes in insurance coverage lately, too.
3. Make sure you’re using modifiers correctly.
Desperate medical practices often misuse modifiers in an attempt to generate some revenue. Unfortunately, they often wind up committing fraud when they do. Modifier 25 is the biggest culprit.
Remember, when you’re billing you can usually bill for a procedure or for the office visit, but for the most part you cannot bill for both.
Office visit fees are typically quite high because it is expected that the patient might need to talk to you about multiple issues. Make sure you are only using Modifier 25 when there is a significant difference between the procedure and the activities that would normally take place during a routine office visit. Simply writing a second prescription for an unrelated issue doesn’t count!
Every time doctors misuse Modifier 25 they invite the insurance companies to give their bills even more scrutiny, which can delay legitimate payments. Make sure the entire staff is trained on when Modifier 25 use is appropriate, and when it isn’t.
4. Failing to get help when you need it.
If a significant number of insurance claims are being denied to the point where your practice is facing financial ruin then it is time to reach for outside aid. Chances are, there are pervasive problems which can benefit from external evaluation by a qualified claims resolution service. Such a service can often help doctors recoup significant monies before the practice goes under.
In fact, practices which have committed every other major mistake have managed to stay in the game by taking advantage of our claims resolution services. We truly care about doctors and their practices, and we know every trick insurance companies use to get out of paying claims. This means money in the bank for you and the chance to keep on treating patients for another day.