Denials, unfortunately, are a way of life in the billing world but it doesn’t have to be that way. As a billing company for physical therapy, we see our share of denials. What we see is very likely what in-house billers see, but it is how you handle them along with making the necessary changes that can decrease them. Denials are not as mysterious as you might think. The majority are due to simple errors that can be eliminated when everyone in your organization takes part in the entire administrative process, pays attention to detail and communicates.
And the list goes on. Any one of these errors will cause a delay in processing the claim. When you have to go back to the source to correct the information, you are now paying for the job to be done right a second time.
We also get a surprising number of denials due to the therapist:
These denials can get complicated and they take a little longer to fix and get paid on. Once again, it is costing money to get it right the second or third time.
Therapists must be sure that they are providers before seeing patients in network. A therapist cannot do the work and bill under another therapist. There are circumstances where co-signing may be acceptable but that means knowing ahead of time what the requirements are before patients are seen. If a claim is denied because the treating therapist is not a provider, you cannot take that claim and resubmit under another therapist – those initial claims will be denied and most likely end up being written off.
Denials due to not having a referral or authorization on file are becoming more problematic in that more and more insurances are not able to back date them. If that happens, you will not get paid for the visit.
Another rising issue is claims being denied due to patients not being eligible for therapy. This happens because benefits were not checked thoroughly before the patient was seen. They may not have either in or out of network benefits, benefits are exhausted for the year, their plan was terminated or their new insurance plan was not entered into the billing system when the information was obtained. Many Medicare patients are denied because we bill Medicare when we should have been billing a Medicare Advantage plan. This information needs to be clarified when the patient schedules the first appointment.
Other denials we see regularly include:
All of these denials are a result of processes being broken down and the administrative process not running seamlessly. Denials can be drastically reduced by everyone working together and in particular:
Front desk must:
The bottom line is that every denial costs money, money that employers should not have to lose. So many denial can be avoided. The best billing system in the world cannot fix these human errors. Good information in, good results out.
If you are not at the level you should be give us a call so we can get training started for your employees in our Administrative Power Center (APC) Training Facility. Click here for APC details.
Diane McCutcheon, President
DM Business Management Consulting Services, Inc.
Account Matters – Billing & Collection Services
4 Charlesview Road, Suite 4
Hopedale, MA 01747
P: 508-422-0231 F: 508-422-0234
Here are some interesting facts of the denials our billing company sees every day. Most of the errors we see are due to data entry errors – missing, invalid or incomplete information. This can be related to the patient, therapist or referral source.
If patient information is not verified at the very beginning of the patient’s care you are likely to see denials for things such as “cannot recognize patient as their insured” because: