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    It's time to declare war on costly billing mistakes

    Here are the mistakes seen most frequently—and how you can eradicate them from your practice


    Follow-up: Automated posting is not an excuse to allow payers to process claims without review. Solution:

    • Do not assume the payer is correct.
    • Analyze non-paid claims and payment level for each service.
    • Correct and resubmit mistakes made by office for payment.
    • Medicare has made it clear when denying a claim that the agency is sending a message and does not expect practices to keep making the same mistake. When claims are denied, they should be appealed to demonstrate the mistake was Medicare’s or billing staff should communicate office errors to prevent future errors and then either reprocess with corrections or appeal with documentation.
    • Do not fall behind. Lack of claims follow-up is a compounding error and timely follow-up is well worth the effort. Attention to detail, even on small claims, adds up quickly. PRS  contracts to work accounts receivable projects for multiple practices around the country with excessive A/Rs due to lack of time, staff, and/or neglect. Many of the unpaid or underpaid claims can be systematically identified, repaired, resubmitted, and collected.

    In summary, physicians, as leaders of the team, need to be more knowledgeable and more involved, and pay attention to the details. In addition, they need to demand excellence in education and performance by their entire team. Conducting periodic checkups is required. Being too busy taking care of patients and ignoring the business you run can be very costly.

    Read: When can modifier –25 be used with an E/M code?

    Physicians are very trusting and hire people that they know have the expertise to do the job. They don’t question their expertise or the jobs they’re doing. This is a good thing in many ways. However, to quote W.C. Fields: “Trust everyone, but cut the cards.” Each employee must be held accountable for their actions. The office needs to know that everyone who touches the many steps in the revenue cycle has the knowledge, expertise, and understanding of the tools and expectations to do their job. In addition, staff members should be encouraged to update and continue their education.

    We encourage you to look at your data entry, documentation, billing, and collections in depth throughout the year. Whether you own the business or are employed, are “hands on” or are detached from the billing process, you are ultimately responsible for bills submitted in your name. The battle to end billing mistakes will require continued analysis, diligence, and leadership.

    More from Urology Times:

    Medicare final rule: Urologists’ pay set to decrease (again)

    How to get reimbursed for BPH water vapor ablation

    Practice ‘report card’ tracks performance

    The information in this column is designed to be authoritative, and every effort has been made to ensure its accuracy at the time it was written. However, readers are encouraged to check with their individual carrier or private payers for updates and to confirm that this information conforms to their specific rules.

    Subscribe to Urology Times to get monthly news from the leading news source for urologists.

    Ray Painter, MD
    Urologist Ray Painter, MD, is president of Physician Reimbursement Systems, Inc., in Denver, and is also publisher of Urology Coding and ...
    Mark Painter
    Mark Painter is CEO of PRS Urology SC in Denver.


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