5 Tips for Avoiding Rejected Medical Claims and Audits

5 Tips for Avoiding Rejected Medical Claims and Audits

Healthcare practitioners can run into fiscal trouble when they have numerous claims rejected. When that occurs they have to undergo an appeals process that can further delay payments. If they have too many claims rejected, suspicions of fraud may be raised, and that can result in a time-consuming audit. The best remedy for all of these scenarios is to simply avoid having your claims rejected by payers. Here are five quick tips that will help you do just that.

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Get the Basics Right

Often delays in payments are caused by claims being denied due to a simple clerical mistake. The basics include simple things such as making sure that the patient’s name, date of birth, insurance provider, insurance number, etc. are correct. Input of information must be accurate, and even the slightest error will result in a claim being rejected.

One other basic that needs to be correct has to do with submitting a complete claim form. Too often payers receive forms that are not completely filled out or that lack the authorized signature needed. Such errors should never occur in the first place.

Double-Check Codes

Make sure that you have the right codes and that all of the needed codes are included. These codes need to conform to your SOAP notes, as these may become important if you undergo an audit. If coding mistakes are habitual, this may trigger an audit. The codes are the way in which you can communicate accurately what you have done and for what you are seeking reimbursement. Get them correct the first time.

Double-Check Fees

Make sure that your fees are accurate and that they reflect industry standards. Exorbitant fees will draw attention and an ongoing parade of medical claim forms that have high fees and involve services rendered during a short period of time have a good chance of both being rejected and drawing the attention of investigators.

Accuracy in Billing

Make sure that the services for which you are billing were actually performed. Never approximate what was done, include services that were not administered, or double-bill for the same patient. Although you may accidentally engage in such practices or this may happen due to sloppy bookkeeping, it may result in your claims being denied, and, if a pattern is perceived, in an audit and/or investigation of your billing procedures and your practice.

Billing and Coding Professionals

A medical billing and coding company will be on the lookout for all of the mistakes and inaccuracies noted above. It is their job to submit medical claims that are accurate and truthful. Therefore, if they have questions regarding the accuracy or veracity of a claim, it is their job to contact you.

Still, ultimately, you are responsible for your medical billing. Get the little things right, keep accurate records, know how to utilize codes properly, and make sure that you can back up anything for which you are billing. If you do these basic things, the rate of rejection of your medical claims will be low and your cash flow will remain steady.

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