Common Billing Problems Medical practitioners and clinics face.

1. Not coding at the highest level of specificity - general-level coding or under coding can equal a rejected or denied code. The problem is that some billers are only minimally educated on coding.

2. Not having access to the provider - while providers may not always be available to consult on difficult-to-understand claims, you need a good coder to use the maximum attempts to try and clarify a report. 

3. Failing to use up-to-date code sets - effective coders need to stay educated on industry coding standards at least every 6 months

4. Claim is missing information - a detail-oriented payer will notice omissions and count such omissions as a reason for denial.

5. Late Claim submission - Some billers simply overlook billing out claims, working rejections and missed visits. It is recommended that the biller submit claims at the end of each day and work missed visits and rejections timely.

6. Not Chasing Late Payments - Claims are being lost, never know whether the receipt of the claim is acknowledged by the payer and claims are not being followed up timely is  becoming a challenge for physicians and practices. In turn, practices end up losing tons of money. A desirable denial rate for a practice is under 5%. 

7. Lack of aggressive appeals - the Medical Group Management Association found that only 35% of providers appeal denied claims, a percentage that should be much higher. A top-notch denial management system will inspect every single denied claim and ensure it is correct and appeal where necessary.

8. Claim is not up to payer standards - some payers are more sensitive than others to claim issues, knowing which payers are the pickiest ensure the most flawless claims possible.