3 Steps to Avoid Denials in Orthopedic Billing

To ensure that you get payment of your insurance claims in a timely manner is a herculean task for an orthopedic practice. Multiple reasons exist due to which claims are denied by an insurance company.  Many of these reasons can be fixed easily by any office personnel, whereas others may need detailed and expert review done by a professional certified coder. Three steps to avoid denials in orthopedic billing are described below:

Always verify information related to insurance

The first or initial step to avoid denial in orthopedic billing is to always verify information related to insurance. One of the major reasons why orthopedic claims are being denied is due to inaccurate information related to insurance. Verify insurance information for its accuracy with both returning and new patients. Contact the patient’s insurance company and check coverage periods and dates. Calculate deductibles and always collect copayments when the patient is visiting your office. Consider that there is limitation to each and every policy. Avoid making errors when a patient has already claimed maximum benefit within an insurance policy or they are receiving services that are not covered by the policy.

Always get accurate information of the patient

The second step to avoid denial in orthopedic billing is to get accurate information of the patient. According to estimates, errors are found in 30-40% of medical bills submitted. Simple errors such as incorrect spelling of the patient’s name or missing SSN (social security number) can result in annoying claim denial. Familiarize yourself with charts of the patient, check patient’s name and their diagnosis code. Also make sure that the information is accurate and corresponds to the surgery or procedure performed. Insurance denials may go for rebilling but the process takes more time and will lead to delay in the payment of insurance claim. Furthermore, ensure that the staff at the front office analyzes all the denials and use the information collected to optimize processing of claims and reduce overall denials.

Automate or Outsource the Process of Billing

The third or final step to avoid denial in orthopedic billing is either to automate the process of billing or to outsource it to a third party (company), which specializes in orthopedic claim processing. You can incorporate a computerized claims checker (scrubber) that may be integrated by using paper charts. It can check claims before submission. You can convert your practice to electronic health record (EHR) system and then link claims management system to your electronic health record system to send claims to insurance companies. If you choose to outsource your medical billing process to a company specializing in orthopedic claims processing, ensure that they are using an electronic health record system and effective software for claim scrubbing. Coding errors, which are a big hindrance in the billing denial process, may be largely avoided using these systems.

To conclude, denials in billing can cause great trouble for an orthopedic practice; however, by following the above-mentioned steps, you can minimize these denials and save significant amount of time and money. When you are deciding on how to manage the denials in orthopedic billing, try to take the input of your office staff and entire group of physicians in the practice.

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