Are Your Ophthalmology Billers Correcting Rejected Claims Within 24 Hours?

By Michael Carroll on August 26, 2016

“Time is money.” That cliche is certainly true when it comes to submitting medical claims. While billers are diligent about submitting original claims within the payer’s time frame, rejected claims often slip through the cracks.Healthcare IT News reported that one data scientist estimates providers could recoup millions by simply resubmitting claims that were rejected for ICD-10 discrepancies. “If claims are the lifeblood of providers’ operations, then denials are a virus that threatens their financial health,” wrote its authors. The American Medical Association (AMA) estimates the cost savings for electronically submitting claims verses doing it manually to be $23,126 per physician. However, that savings is wasted if you are losing money by not quickly resubmitting rejected claims. Do you know if your billers are correcting and resubmitting all electronic claim rejections within 24 hours?

Denied Vs. Rejected

These terms are often used interchangeably. However, in the medical billing arena they have very different meanings. A rejected claim is returned because problems were detected by the payer, including errors related to coding, patient information or insurance identification numbers. Denied claims have been processed by the payer and they have determined it cannot be paid. Denied claims can be appealed and resubmitted. There’s no appeal necessary with rejected claims since they have not been processed. Simply correct the wrong information and resubmit.

The first step in streamlining your billing process is to differentiate between denied and rejected claims. Rejected claims can be quickly corrected and resubmitted within 24 hours. Ensure this is part of your billers’ daily process. Denied claims, on the other hand, take more time to evaluate and determine if an appeal is appropriate. While processing appeals is important, don’t let rejected claims end up in the same pile. Rejected claims should be given priority, ensuring reimbursement comes quickly and cash flow is not interrupted.

The Effects of Waiting 

As noted, rejected claims are typically returned with an explanation of error. So, there is simply no reason to wait. Make the correction and electronically resubmit within 24 hours. The longer insurance payments take to get posted, the longer it takes for patients to be billed for the remaining balance or for secondary insurances to be filed. Delaying the processing of a rejected claim delays the entire accounts receivable process. When this happens over and over, it affects cash flow and makes it impossible for providers to accurately gauge how the practice is doing financially.

The AMA’s National Health Insurance Report Card puts payment accuracy rates among insurance companies at62.08 percent. This means the even “clean” claims are often rejected or denied. Nearly 40 percent of the time, all your staff needs to do is resubmit the rejected claim. Delays in submitting the original claim, then delaying again when submitting the rejected claim, on top of errors by the insurance company could potentially throw the practice’s cash flow off by months. While you can’t control errors made by the insurance company, ensure your billers have a process in place to control the timeline on their end.

Lastly, errors in billing also affect your reputation with patients. Medical Billing Advocates of America noted an increase in billing complaints by patients. It’s no wonder. The organization says over 80 percent of medical bills contain errors. If inaccurate statements go out from either your office or a “statement of benefits” from the insurance company, patients will perceive the practice as unorganized. While a rejected claim may be a simple fix, the patient receiving an inaccurate statement will build a perception that’s difficult to turn around.

Double-check Before Resubmitting

As noted above, insurance companies are not perfect. It’s possible one error was spotted in the claim and it was bounced back without checking for any other inaccuracies. Prevent further delays by reviewing the claim before resubmitting. First, check the basics. Is the patient’s name, date of birth, insurance number, etc. all correct? Is the practice’s information correct, including address, phone and physician name? Double-check the insurance provider’s information. Ensure that codes and fees are accurate. Even small errors will result in more delays.

Get Help

The billing process is one that must be exact. Outsourcing the process may seem like an initial expense, but could save the practice money in the long run. Business News Daily asked for medical billing tips from experts in their field. Among their top six tips were “Consider employing a reliable billing company.” The experts encouraged, “Find a company that is a real advocate.” Consider some of the benefits.

  • Experience. It costs more to hire experienced billers and coders, leading many practices to hire those with less experience. A billing service hires the best of the best, giving you access to years of expertise and experience. Simply put, if you aren’t making money, the billing service isn’t making money. Their goal is to monitor every claim, ensuring it is paid.
  • Quicker pay. The number of days a claim sits in AR has a significant effect on the practice’s cash flow and bottom line. A professional billing service prevents claim errors up front. They are dedicated to resubmitting rejected claims immediately. They make it their business to know each payer’s requirements so that no detail is neglected.
  • Savings. The AMA’s report card estimated that $12 billion can be saved through increased claims automation. An efficient billing company is in the business of knowing every streamlining strategy. That savings is passed on to you in the form of more collections and decreased administrative expenses.

Let Agnite Health LLC be your billing advocate. Contact us to find out how much you could recoup.