The purpose of this post is to help assist those with questions they have concerning their business or medical practice. The Callagy Law team is knowledgeable in many law practice areas and will frequently post topics ranging from Medical Revenue Recovery, PIP, Workers Compensation, and Commercial Insurance. We hope to have this blog shed a light on many common questions.
Billing insurance companies and collecting what you are entitled to collect can be a difficult process for medical providers. There are inevitably coverage issues, difficulties with navigating the ambiguities of policies, correct coding problems, and carriers will look for any discrepancy as a way to avoid payment. Below are a few tips to help overcome or at least alleviate some of these issues.
Let’s begin with coding. Employing a certified coder is a start. It is best these days to hire a professional, who will stay educated on the latest coding practices and information, rather than simply someone who has general knowledge. Coding has grown and continues to grow more and more complicated. A certified coder reviewing the National Correct Coding Initiative (NCCI) tables will ensure that bundling errors do not hold up payments. A professional coder can navigate the labyrinth of codes so as to limit the carriers’ ability to delay payments for coding deficiencies.
Insurance policies too can be problematic. Whenever possible a medical provider should obtain as much information about the insurance policy relevant to the treatment as possible. This might mean the declaration page of an automobile policy or the health benefit plan description for a commercial insurance patient. Knowledge of the policies and plans will help reduce, if not, eliminate unknown coverage pitfalls, and provide a better knowledge base of likely reimbursement levels. Too often providers render services having little or no real knowledge as to what the reimbursement levels will be or whether or not they are even likely to be reimbursed.
The medical documentation also can raise issues. A medical provider must make sure the supporting documentation matches the diagnosis codes, and should be very specific. It is self defeating to be cavalier about explaining the need for and the medical necessity of all aspects of the treatment. It is important to be aware of codes that need specific explanations for payment and ensure your documentation has the necessary explanations.
Finally, confronting denials as and when they happen, as well as having a competent and aggressive legal time at your disposal, will pay big dividends. You need collection personnel with tenacity and organization skills to pursue relentlessly the frequent follow up calls that are necessary. Knowing payer systems and rules and asking the right questions of claims adjusters is also important.
These are some simple suggestions to combat the revenue roller coaster many providers face. As a liaison for Callagy Law, I have seen some of my providers struggle with insurance payments, and these basic steps can help alleviate that struggle.
We hope you found the information provided in this article helpful to various questions you may have had concerning the healthcare industry. For information pertaining to our services for medical providers, please click here. Please note, Callagy Law has recovered over $200,000,000 for medical providers, and that number grows daily. Our team of knowledgeable PIP Arbitration attorneys are ready to help you. Please free to reach out to Sean Callagy of Callagy Law at any time for questions you may have concerning personal and business matters. Callagy Law offices are located conveniently in Paramus, NJ. Beyond the scope of information, Sean Callagy has developed multiple areas of our healthcare legal practice and business coaching. Feel free to connect with us on Facebook, Twitter or LinkedIn! Additionally you can subscribe to our daily videos on YouTube.
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