Medical billing claim rejections can have a significant impact on the revenue cycle of a medical practice. Unfortunately, many of these rejections stem from common mistakes made by front end medical personnel. Medical office managers and doctors must understand these mistakes to correct and prevent future denials.

Why Are These Mistakes Happening?

Before addressing specific errors, it’s essential to consider why these mistakes are occurring in the first place. Two primary factors often contribute:

1. Speed Over Accuracy: In the fast-paced environment of a medical practice, staff may prioritize speed over accuracy, leading to errors.
2. Lack of Training and Knowledge: Without proper training, front end staff might lack the knowledge needed to input patient demographic and insurance information correctly.

Common Mistakes Leading to Claim Rejections

1. Incorrect Patient Information

One of the most common errors is the incorrect entry of patient information, such as name, date of birth, or insurance details. Even a minor typo can lead to a claim rejection. Furthermore, if the patient is not the insurance plan subscriber, you must also obtain the subscriber’s name and date of birth. Incorrect information may lead to claim denial.

Solution: Establish a double-check system where the staff member entering the information reviews it thoroughly upon completion. Also, if staff complete eligibility ahead of the patient’s visit, many of these issues can be corrected in advance of being sent to the billing team.

2. Failure to Verify Insurance Eligibility

Not verifying insurance eligibility before a patient’s visit can lead to claims being denied due to lack of coverage. Also, as stated above, verifying eligibility ahead of the visit will allow staff to catch any information that may have been entered incorrectly, such as a wrong date of birth or insurance member ID number.

Solution: Establish a routine procedure to verify insurance eligibility for every patient visit. To allow time to address any issues, such as inactive coverage, avoid reviewing eligibility on the day of the visit.

3. Wrong Insurance Listed

Selecting the incorrect payor when entering the patient’s insurance information can lead to claim denials. A common area of confusion we frequently encounter is staff uncertainty about which BlueCross BlueShield plan to select for patients with out-of-state Blues plans. In these cases, staff should choose the local Blues plan. However, we have observed that staff sometimes struggle to identify the correct local Blues plan. If uncertain, staff should refer to the back of the insurance card for guidance.

Solution: Make a list of payer specific information commonly encountered by your staff. Always secure a scanned copy of both the front and back of the insurance card.

How to Prevent These Mistakes

Understanding the root causes and specific errors allows you to take proactive steps in preventing claim rejections. Here are some strategies:

1. Prioritize Training: Invest in regular, comprehensive training sessions for your staff. Cover topics like accurate data entry, current coding standards, and payer-specific guidelines.
2. Implement Quality Control Measures: Establish procedures for double-checking information and conducting periodic audits to catch errors before submission.
3. Use Technology: Utilize practice management software that can flag potential errors and ensure compliance with the latest coding standards.
4. Foster a Culture of Accuracy: Encourage a culture where accuracy is valued over speed. Recognize and reward staff who consistently demonstrate attention to detail.

Conclusion

By identifying and addressing these common mistakes, medical practices can significantly reduce claim rejections and improve their revenue cycle. Training, quality control, and a focus on accuracy can go a long way in preventing these errors.

If you need further assistance or personalized training for your staff, consider booking a consultation with our experts. Together, we can help you optimize your practice’s billing processes and minimize claim rejections.

Ready to take your medical practice to the next level? Contact us today to learn more about how we can help you improve your billing accuracy and efficiency.