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Why was my claim returned?

Why Was My Claim Returned?

The primary responsibility of a medical biller is to properly file claims to ensure that the medical provider is reimbursed for services rendered. Unfortunately, it is not uncommon for billers to make human or electronic errors while entering claim data. As many as 80% of medical bills contain one or more errors that increase the risk of denied claims, and each denied claim means lost revenue. Billers have to deal with two essential elements of medical care – health and money. For this reason, they must check to ensure they make as few mistakes as possible while filing claims. However,

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Billing manager reviewing reports with calculator, papers, and glasses on desk with hands crossed.

How to Reduce the Margin of Error in Your Claim Processing

Gaps in claims management strategies lead to frustrating denials. In recent years, the margin of error for medical billing has been as high as 70%. No wonder so many patients are challenging their medical bills. They have lost trust in the insurance claims management process. These challenges cost patient trust, delay payments, and require more investment by you and your staff to get paid for the care and treatment you have provided. What are the best ways to reduce the margin of error in your billing process? Follow these tips to help you master the insurance claims management process and collect accurate

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Rejected and Denied Claims Common medical billing mistakes lead to claims rejections and denials. But just because insurers reject a claim, this does not mean it has been denied. Rejected claims are often not processed because of incomplete or inaccurate patient data or insurance eligibility issues. Often, these claims will ultimately be accepted and paid if the applicable information is corrected and resubmitted to the insurance company. Accurate Information – Begin with the initial contact with the patient and gather information at the time of appointment-setting. Make sure all information is collected and entered correctly, including the patient's insurance and policy numbers, correct spelling of the patient’s full name, date of birth, gender as listed on their insurance information, primary policyholder name and social security number, and billing codes for any services provided to the patient. Eligibility Issues – Front-end staff must verify health insurance status and coverage. Eligibility issues are among the top reasons for claim rejections, and about 8% are rejected because of eligibility problems. Even if an insurance company ultimately determines a claim is not eligible for payment and denies it, the claim can be resubmitted and appealed if additional information can support its validity.

Medical Billing Mistakes that Impact Healthcare Revenue

An estimated 49% to 80% of medical bills contain at least one error, and that equates to revenue loss. Every error increases the risk that claims will be denied, and denied claims cost time, money, and resources to correct. Accuracy is critical in every step of the billing process to avoid such loss.  Common medical billing mistakes can wreak havoc on your bottom line and lead to frustration for you and your patients. Using a reliable clearinghouse is an optimal solution to help minimize human errors and other mistakes that lead to long revenue cycles and denied or rejected claims. By implementing an electronic system, common paperwork errors are avoided altogether. Electronic claim scrubbing will automatically check for errors before sending them to insurance companies, so they can be corrected quickly without the risk of causing a rejection or denial.  Let’s look at how to

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Time is money when it comes to claim processing.

Get Paid Faster: Why Time is Money in Claims Management

Providers are spending millions of unnecessary hours on manual billing tasks, costing them billions. From the moment your patient walks through the door, the clock starts ticking on the claim process. Medical providers aspire to help and heal, not push paper. So why spend so much time and energy on medical claim processing? It is a necessary and time-consuming task that requires accuracy and attention to detail, but too often, it consumes valuable resources.   Simple clerical mistakes cause errors, denials, and slow turnaround time; and losing time means losing money. Manual claim processing unnecessarily causes a double hit to your bottom line, increasing labor demands and

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Hands holding a stethoscope with the word Medicaid between the earpieces.

Frequently Asked Questions about Medicaid Billing

Medicaid was designed to make healthcare affordable to the underprivileged. It is also beneficial for healthcare service providers as it helps supplement their revenue. However, healthcare providers are tasked with processing their patients’ bills and claiming payment from the relevant authorities. This process can seem complex, and clinics often have a lot of questions. Here is an overview of some of healthcare providers’ most frequently asked questions about Medicaid billing.    How is Medicaid Regulated?   Both the State and Federal governments regulate Medicaid. On one hand, the federal government is responsible for governing the program through the Department of Health and Human Services (DHS).

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Medical billing professional focused intently on his computer.

Denial Management. What Is It? How Does It Work?

The rate at which medical claims get denied by insurers is pretty concerning. According to a recent analysis, the average claim denial rate increased by 23% compared to four years ago. For medical practices, this means unpaid services, resulting in lost or delayed revenues, hurting the financial health tremendously.   But before you blame insurers for denying your claims, take a step back and look at your denial management strategy. The fact is, most denials result from wrong information or misinformation in your claims, forcing the insurer to interrupt your revenue flow. What’s more perplexing is that not all organizations commit to following up their claim denials,

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What Is Balance Billing? Is It Ever Legal?

There are numerous types of bills that are applicable in medical practice. The burden of payment can fall on the patient or their medical insurance provider. Some are lawful, while others are not. Therefore, it is important to know about the essential payment concepts and know when they are applicable to avoid facing lawsuits and fines. One of such concepts is balance billing.   What Is Balance Billing? Balance or extra billing is normally the difference between what a patient’s insurance provider is willing to pay based on the cover they offer and what your facility charges the patient for the services they

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5 Billing Tips for Dieticians & Nutritionists

Diet and nutrition providers that are looking to leap into billing with insurance may not know the best place to start. After all, today’s insurance landscape is extremely complicated and can feel daunting if you are not familiar with the process. Many specialists who previously did not accept insurance are beginning to and more and more insurance plans are bringing dietician services under their umbrella of coverage. The realization has been that accepting insurance is a quicker way to get paid for services, it helps make services affordable for patients, and brings in a higher number of patients than without.  Ultimately

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A patient receiving treatment from a chiropractor.

Chiropractic vs Physical Therapy Insurance Billing

When looking at chiropractic vs physical therapy billing, it’s easy to get the two confused. Both disciplines carry some similarities but are ultimately completely different specialties. It is important to distinguish between them, especially when it comes time to bill for services. Utilizing an EDI/clearinghouse partner that is familiar with both categories of claims can be a great resource for providers looking to improve billing/revenue. In the meantime, however, let’s find out what makes these two so different when it comes to billing and claim management.   Likelihood of Coverage  While the two specialties carry great differences, there are a few key elements they share. They both work one-on-one with

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A doctor’s clinical and practice management tools linked together with healthcare interoperability. 

The Importance of Interoperability in Healthcare Billing

With the medical world in the midst of a digital revolution, interoperability is more important than ever. But how do we define this tech buzz word in the context of healthcare in a way that makes sense for practitioners? Simply put, interoperability is as it says, the ability for systems to communicate and operate together.   Today, many practices are onboarding not only electronic health records and clinical tools, but practice management suites that assist with billing and compliance. With all these tools in a healthcare provider’s toolbelt, it’s critical that each software system work together securely. Without seamless communication, the benefits of these tools are greatly hindered. Let’s dive into the details of

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A healthcare provider’s billing staff working with an EHR billing integration to improve their practice management. 

7 Benefits of EHR Billing Integrations

Medical billing is a challenging and demanding process. The nuances that go into filing claims, avoiding denials, tracking bills, coding, and the like can be overwhelming for any clinic.  Delegating the process to a proper billing system can simplify the task tremendously, allowing practitioners to focus on their core tasks. That’s why clinics are generally looking for an EHR system with a ready-to-go medical billing integration like a clearinghouse.   By gaining an opportunity to submit insurance claims quickly and efficiently, practitioners can minimize rejections and denials while getting their money as fast as possible. While they may already have a separate

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close up. man using a keyboard shortcut on a laptop keyboard

Why Use EDI in Healthcare?

As the digital world continues to advance, we are privileged to use various software and technologies that make our jobs easier. One such technology is electronic data interchange (EDI) software. EDI in healthcare allows for improved claims processing with improved security and efficiency for patients and healthcare providers. Medical professionals everywhere are taking the leap and adopting EDI. Keep reading to find out why.  What is EDI?  EDI stands for electronic data interchange, which is a fancy way of saying, EDI serves as the courier of data between two parties, a middleman. When it comes to insurance billing, EDI and EDI clearinghouses are incredibly valuable tools that handle the communication between

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An optometrist performing an eye exam for her patient. 

Why You Should Use Vision Billing Software

Rampant errors in insurance claims and coding may result in delayed revenue cycles for clinics. These errors prevent vision care professionals from realizing the percentage of payments they should from insurance companies. Even when they finally receive these payments, it’s weeks after the claim has been submitted, slowing down cash flow. But billing tools like Apex EDI’s insurance claim clearinghouse remove the headache from the whole process.  About Vision Care Billing Software  An efficient vision care billing software has many benefits for your practice:  Saves time and money  Integrates seamlessly with your current optometry software  Reduces errors in your billing process  Access to web-based claim management and reporting

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Billing employee frustrated on the phone over denied and rejected claims.

What You Need to Know about Denied and Rejected Claims

Denied and rejected medical claims can erode a significant chunk of your practice’s revenue, especially if you’re not set up to manage them efficiently. The good news is that the majority of rejected and denied claims are preventable and caused by common errors. You can make a big difference in your claim rate by identifying problems in your workflow, educating your team, and using the services of a reliable clearinghouse. Here are 5 important things you should know about how claim errors interrupt your revenue cycle.   The Difference Between Rejected and Denied Claims  Denied and rejected claims are not the same and will

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Optician offering glasses to a patient.

Could Retail Optical Benefit Your Practice?

As an ophthalmology or optometry professional, one of the best moves you can make to grow your practice is to incorporate a retail optical outlet as part of your operations. This move makes sense when you consider that one of the key factors that patients consider when choosing eye care is their health insurance.   As a medical professional, a visit to your practice would be billed under their medical plan instead of their vision plan. However, if your patients require a basic examination or to purchase glasses, contacts, or other vision aids that you prescribe to them, the cost would

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