Internal medicine practices see patients with a wide variety of conditions and a significant amount of insurance claims. But billing errors can trigger expensive denials, slow payment and administrative hassles.
In this post, we are going to discuss the most frequent claim denials in internal medicine billing and how your team can either resolve them or prevent them.
False or No Patient Data
The denial:
Claims are denied when there are simple omissions, errors or inconsistencies, like the patient’s name, date of birth, insurance identification number.
How to fix it:
- Be vigilant in checking insurance cards at all visits.
- Train hotel front-desk staff to type in information carefully.
- Use software that verifies for eligibility to help you catch mistakes at an early stage.
A denial can be triggered by very minor typos, so precision is important.
Lack of Medical Necessity
The denial:
Insurers often deny payment if services aren’t medically necessary; quality Medical Billing services help prevent these issues.
How to fix it:
- Make documentation tell the story behind why the service was necessary.
- Use the ICD-10 code for the procedure and diagnosis.
- Do not use generic notes like “check-up” be specific about symptoms or findings.
Refer to payer policies, as each may have different definitions for “medical necessity.”
CPT/ICD-10 Codes Incorrect or Obsolete
The denial:
Misinformation and false or outdated codes frequently result in denied claims. A single number wrong and the application may be turned down.
How to fix it:
- Keep up to date with the latest code sets in billing software.
- Train providers and billers on new codes.
- Compare diagnoses and procedures for congruence.
Given the diverse range of services, accurate coding is a must in internal medicine.
Unbundling Services
The denial:
Unbundling occurs when a service that should be under one code is broken out into separate codes. Insurers mark this up as inappropriate billing.
How to fix it:
- Reviewer payer rules and regulations regarding services commonly bundled.
- Apply modifiers appropriately whenever several services are involved.
- Employ claim scrubbers before submission to nab any unbundling.
Errors here may result not just in denials but in audits too so watch yourself.
Duplicate Claims
The denial:
It is a mistake to resend an identical claim without just cause, this could result in a denial or delay.
How to fix it:
- Before resubmitting, verify claim status.
- Refiling should occur only if the original was denied or not processed.
- Utilize billing software with claim tracking to minimize resubmits unintentionally.
These are frequently the result of communication issues between the billing and admin folks.
Out-Of-Pocket Services
The denial:
At times, a service may not be covered under the patient’s plan, such as preventive or out-of-network.
How to fix it:
- Please check your plan or see coverage details to determine coverage before scheduling the service.
- Have signed acknowledgement for non-covered services by patients.
- Look at insurance portals or call payers if you are not sure.
Transparency is something patients appreciate that also helps avoid billing surprises down the road.”
Missing Prior Authorization
The denial:
A few tests or treatments require prior authorization by your insurance company. If it doesn’t, the claim will be denied, even if the service was needed.
How to fix it:
- Designate one person to ensure authorizations are kept track of by staff.
- Compile a list of operations that need acceptance.
- Store authorization numbers and expiration dates in the patient’s record.
Do not assume all routine services are included clarify at each visit.
Final Thoughts
Internal medicine billing can be a challenge, but with the right systems, and training and tools, you can avoid denials. From looking up patient info to confirming codes and coverage, a few missteps can lead to a bad outcome.
With these common factors corrected, your practice can increase revenue, cut down on rework, and spend more time with patients instead of paperwork. To schedule your practice analysis with the highest standard of care and visit The Medicator’s, visit our website.
