Billing can be time-consuming, tedious and frustrating to say the least. It can be even more frustrating when the medical claims that you worked so hard to submit are bounced right back. What are the most common reasons that a medical practice’s claims are bouncing back after submission?

Minor Errors

Just like it’s easy to miss a comma in an email or mistype a word, it’s also very easy to make minor errors in medical claims. Reimbursements are often denied or delayed due to seemingly-small mistakes, like forgetting to include a plan ID number or mixing up a letter. Because front desks are already so busy and overwhelmed, mistakes can fall through the cracks. One winning solution to this is using a professional outsourced claims processing service that will review claims before submission and look just for errors. The time saved from going through a resubmission is much less than time spent reviewing claims.

Missing Information

Another common reason that claims are bouncing is insufficient information. You always need to submit documentation to back up claims, and you should always supply each insurance provider the information that is requested to process payment in an expedient manner. Again, it is much easier to put the effort into properly gathering everything beforehand instead of needing to go back in the future to find the right documentation.

Skipping Authorization

If you needed authorization before a procedure was performed and it was not secured, you shouldn’t be too surprised that a claim bounced back your way. You should verify whether or not prior authorization is needed before you schedule the procedure. When it is time to bill, ensure that you also include the prior authorization number on the submitted claim. While prior authorizations can seem like an annoying extra step, they are vital to ensuring that claims receive approval in a prompt manner.

Changes on the Patient End

One of the most common reasons for claim denial isn’t necessarily your practice’s fault at all. Claims are often denied because a patient’s coverage has changed, the plan or payer has been changed or coverage has been terminated altogether. Even if you think everything is the same as the last time you spoke with a patient, you should always ask to confirm insurance information and see an insurance card at each appointment.

Trust the Experts at Vetters Enterprises for your Billing Needs

Vetters Enterprises specializes in practice management, private practice business support and revenue cycle optimization. We can perform in-depth assessments of your practice or facility and identify potential issues. Let us keep your business as healthy as you keep your patients! Give us a call at (443) 352-0088.