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Is your practice constantly faced with the problem of under-coding?

Under-coding is defined as the process of medical coding wherein the codes used are not reflective of the full extent of treatment that the patient received. It is often the result of failing to abstract every code from the medical record or to select the highest specificity of codes. Like overcoding, it can lead to rejected or denied claims, not to mention decreased revenue. But under-coding can also lead to other, more serious problems, which is why it is crucial to avoid this mistake.

The Problem with Under-Coding

Despite resulting in lower revenues for practices, under-coding is still considered fraudulent and can lead to investigations or audits. Some coders think that under-coding is “playing it safe” when you’re unsure, but really it isn’t. It can be seen as inducement, or the practice of offering a free service to patients in order to encourage them to avail of a service that is covered by the insurance provider. This can lead to legal action on the grounds of fraud and abuse.

What’s worse than having a stubborn patient? For a practice, it’s having no patient at all.

No-shows and cancellations are the bane of medical practices. They leave you unable to meet your daily target, cause undue stress and chaos, kill minutes of your time and consequently, the profit you could have earned making those minutes useful. Research shows that practices typically lose an average of 1 to 2 patients a day due to no-shows and cancellations. This can add up to almost $100,000 in annual profits lost! Even if a single no-show a day seems negligible, it definitely won’t be that way in the long run and on your bottom line.

Thankfully there are a number of simple ways you can effectively decrease no-shows and cancellations in your practice, and get paid even when they happen:

1. Always set appointment reminders. Make it a requirement to set appointment reminders with patients the moment they set an appointment with you. Ask your patients whether they would prefer email, text message or phone reminders, and also at what times they would prefer to receive the reminder. In most cases, it’s most effective to set these reminders after hours, when patients are less preoccupied with daily tasks.

It’s inevitable for practices to come across patients with insurance payment problems every now and again. These can range from patients simply being confused about why they have to co-pay or don’t understand their explanation of benefits statement; to irate patients who refuse to pay or withhold payment that was mistakenly sent to them by their insurance company. When these situations arise, it’s important for your staff to know how to handle them properly as their actions or inaction can affect how the entire practice will be viewed. They also directly affect how efficiently your practice will get paid and consequently, your bottom line.

So how should you deal with patients in these types of situations?

To outsource or not to outsource? That is the question that a lot of medical practitioners face when it comes to their billing. After doing billing in-house for years, some practices may find shifting to outsourced medical billing services as more of a risk, as it turns majority of the control on collections over to the billing services provider. But outsourcing can be extremely beneficial, if it is done within the right circumstances.

So when is the best time to outsource your billing service? Below are some of the scenarios where outsourcing has proven to be the better alternative:

It’s a fact that a large part of a practice’s revenue comes from successfully processed claims. And it’s also a fact that even one small error in the processing of these claims can mean immediate rejection or denial, and the loss of revenue.

These facts are the reason why it is absolutely critical that claims be filed free of errors. In an office that handles numerous claims daily however, it can be difficult to keep track of every single detail in each claim. Knowing the most common errors committed when filing a claim can remedy this. By taking note of the most common errors or having a checklist of these nearby when filing, you can make sure to avoid most, if not all rejections or denials.
It’s a fact that a large part of a practice’s revenue comes from successfully processed claims. And it’s also a fact that even one small error in the processing of these claims can mean immediate rejection or denial, and the loss of revenue.

Does it seem like you’re working more hours on your practice yet not making more money? It may be because you’ve got several “leaks” in your practice.

These leaks are areas in your practice that unknown to you do nothing but consume your revenue. From before the actual patient visit to well after the patient leaves the clinic, medical practices can lose a lot of money because of these leaks. Could your practice be among those plagued by these leaks? Read on to find out and plug those leaks before they pull the plug on your practice.

Before the Patient Visit

Even before the actual patient visit, practices can lose a significant amount of income due to negligence in verifying insurance eligibility, which leads to claim denials and delays. According to the American Medical Association (AMA) 25% of private payer denials are directly caused by patients being ineligible for benefits.