Incorrect coding is a bigger issue than most practices realize. Due to the implementation of new policies like ICD-10 and new codes, it can be easy to code incorrectly. Beyond coding issues, there are many reasons that claims go unpaid.

#1 Patient Deductible

If a patient changes insurance plans, you will need to make sure that you are networked in the new plan and get preauthorization to be able to serve that patient. If your patient has an unmet deductible, you can also get denied.

For example, if your patient’s co-pay is $20 but they have not yet paid their deductible, you will not receive even $20 from the insurance company. Your claim will get denied.

#2 Waiting Time

If you wait to file your taxes, you could incur issues with reimbursement. Most insurance companies allow practices 90 days to a year. Some only allow 30 days. The waiting period begins the day the service is made. Any claims filed after the allotted time are rejected.

Why are your claims taking so long to file? The culprits could be disorganization and a lack of time. Unless you have a third party revenue management company, you may find that your staff is not equipped or does not have the time to get all of your claims filed in a timely manner.

#3 Primary Care Provider Referral

Sometimes insurance companies require a referral from your patient’s PCP before any services can be rendered. Most insurance companies also have a strict policy regarding how many services can be rendered in one day. For example, for behavioral health and group therapy, only one service a day is allowed.

ClinicAnywhere Can Help

Reduce your paperwork and get the reimbursement you deserve from insurance companies. ClinicAnywhere is a Platinum Partner with HealthFusion®. We have the revenue cycle management software to help get your practice out of the red tape and back to the clinic. Contact ClinicAnywhere today to learn more.

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