Billing errors are pretty common in the healthcare setting. Nursing homes face denials of 5% to 10% of submitted claims due to nominal errors in their invoices. It leads to serious financial setbacks, regulatory penalties, and unnecessary stress for both, nursing homes and patients.
Mistakes in documentation, coding, and compliance are most common in nursing home bills. That results in claim denials and delayed reimbursements. Also, sometimes the nursing home may face legal consequences. Hence, nursing home billing services must put extra effort into eradicating the unfortunate billing errors for unhindered cash flow. In this blog, we will discuss the five most common billing errors with effective solutions. Let’s get started.
Wrong Insurance Verification:
Insurance verification is the key step in the nursing home billing process. Billers must check the status of the patient’s insurance policy to ensure eligibility and coverage. It helps providers understand the treatments, medications, and services covered under the patient’s insurance policy. However, several claims get rejected by payers due to the following reasons –
- Services not authorized or covered by the plan
- Insurance has been terminated or is no longer eligible
- Maximum benefits have been met
In such conditions, nursing homes fail to get reimbursement from insurance payers and lose significant revenue.
Solution:
Billers must thoroughly verify every patient’s insurance plan. They must ensure the insurance plan is active and treatment, medication, and other services come under its coverage. Proper insurance verification will ensure faster reimbursements, so nursing homes can thoroughly concentrate on patient care.
Incorrect Patient Information:
Another frequent error in nursing home billing is incorrect or incomplete patient details. When patients initially visit nursing homes for treatment, they need to provide the necessary details for registration. The details must include –
- Patient’s name, address, date of birth, and Social Security Number
- Patient’s insurance ID number and more
Even a nominal typing mistake while capturing patient data can result in claim denials. That can lead to payment delays or increased patient out-of-pocket expenditure.
Solution:
Nursing home staff must verify patient information at every stage of the billing process. They must cross-check the data with electronic health records (EHR) to ensure there are no unwanted errors. Eradicating errors in patient data will ensure seamless and faster claim reimbursement from payers.
Missing Prior Authorization:
Prior authorization is one of the most crucial steps in nursing home billing. Providers must send the details and costs of the prescribed treatment plans and medications. Insurance companies will thoroughly verify the necessities of the proposed treatment plans. Also, they will check whether the treatment is covered under the patient’s insurance plan. However, more than 10% of claims are denied by payers due to prior authorization errors.
Solution:
Nursing home billers must have a thorough understanding of the complete prior authorization requirements along with its documentation needed as well as its policies. Thus, a prior authorization professional must include detailed patient information for prior authorization, having complete knowledge about its initiation, approval as well as follow up to ensure a seamless prior authorization process.
Applying Wrong Medical Codes:
Coding errors are the most common reason for claim denials. Using outdated codes, incorrect modifiers, or mismatched diagnosis codes, significantly triggers claim rejections. Moreover, healthcare authorities update medical codes quite frequently and that adds another layer of complexity to nursing home billing.
Solution:
Medical coders must have comprehensive knowledge of updated medical codes that apply to the particular medical services rendered. In-house staff often lacks these finest details. Hence, employing outsourced medical coders will significantly reduce coding errors and claim denials due to that.
Insufficient Document Submission:
Incomplete or missing documentation is a leading cause of claim denials. Payers require all-inclusive documentation to justify the necessity of rendered treatment plans along with medical reports and test results. About 5% to 10% of claims get rejected by payers due to incomplete documentation.
Solution:
Nursing homes must train their staff regarding proper documentation protocols. Moreover, they must ensure all medical services are properly recorded in the EHR system along with supported documentation. The documentation errors are easily preventable, only providers must employ professional medical staff to collect and submit patient’s documents.
The Bottom Line:
All these common billing errors are easily avoidable, and it is possible when nursing homes employ dedicated staff to ensure seamless billing. However, employing in-house billing experts is significantly costly and can affect their yearly revenue.
Alternatively, nursing homes can hire outsourced nursing home billing services. They will reduce 80% of operational costs as well as ensure faster and maximum reimbursements. It will benefit both nursing homes and patients. While outsourced billers look after the entire billing and coding process, providers can concentrate on delivering top-notch patient care. Precisely we can say that outsourcing will reduce costs and ensure better patient outcomes.
