Medical Billing

The Most Frequent Medical Billing Errors That Companies Make

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Medical billing errors are prevalent and can happen to any company. They often stem from a lack of understanding of the medical industry or insufficient staff who know how to code properly, especially in the medical billing companies. There are many ways to reduce these errors, but it is important to be proactive before your customers start complaining. At Integrity Billing, we specialize in billing and other healthcare management services. This blog post will discuss the most frequent medical billing errors companies make – some you might be making yourself without even realizing it.

1. Not understanding the medical industry.
This is one of the most common medical billing errors companies make. They may not understand what services are covered by insurance, how to code procedures properly, or what is considered a reimbursable expense. All of this can lead to mistakes when submitting claims and result in lost revenue for your company. However, outsourced medical billing services can help solve this problem.

2. Failure of verification of benefits for insurance.
Another common mistake companies make is failing to verify insurance coverage. Before submitting a claim, it is important to make sure that the patient’s insurance plan covers the service you are providing. If it’s not, you could be on the hook for the full cost of the procedure.

3. Not submitting claims on time.
This medical billing error can often be attributed to a lack of staffing or understanding of how the system works. When claims are not submitted on time, you run the risk of them being denied due to insufficient documentation. And if they are denied, you will have to resubmit them. However, an outsourced medical billing service provider can help solve this mistake.

4. Incorrect coding.
This is one of the most common medical billing errors and can lead to significant financial losses for your company. Incorrect coding can result from not having enough staff familiar with medical coding guidelines, or it could be due to human error. Either way, it is important to have a system to check coded claims before submitting them to ensure accuracy.

5. Not following up on denied claims.
If an insurance company denies a claim, it is important to follow up on it as soon as possible. Often, all you need to do is provide additional documentation, and the claim will be approved. However, if you don’t follow up on denied claims, you could end up losing money.

6. Filing duplicate claims.
This medical billing error often occurs when companies submit duplicate claims for already billed procedures. This can be a costly mistake, leading to claims being denied and additional administrative work.

7. Not verifying patient insurance eligibility.
It is important to verify that the patient is eligible for coverage before providing services. If you provide services to someone who is not covered by their insurance plan, you will be responsible for the full cost of the procedure. Therefore, verification of benefits is essential to ensure the eligibility of patients.

8. Failing to follow up on unpaid bills.
Often, bills go unpaid because patients forget or don’t have the money to pay them. Therefore, it is important to follow up on unpaid bills on time to get paid what you are owed.

These are just some of the most common errors that medical billing companies make. By being aware of these mistakes and taking the necessary steps to avoid them, you can ensure that your medical billing process is as accurate and efficient as possible. If you are looking for more tips on how to improve your medical billing process, contact Integrity Billing.

Why Substance Abuse Billing is Important

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Substance addiction is very common throughout the world. But it is not something that should be taken lightly. When people regularly consume “substances” in excessive quantities, they’re called addicts. But substance abuse and addiction are two different things. 

Substance abuse refers to the use of alcohol or any other drug, be it legal or illegal, in large quantities. Substance abuse can be cured with proper rehab facilities. On the other hand, addiction is harder to get rid of. 

Rehab centers and other healthcare facilities help individuals with substance abuse and addiction problems. But these rehab centers also need an income to run properly. To get stable revenue, they need to make proper billing. Even the slightest bit of mistake in billing can cost rehab centers a lot of money. Hiring a substance abuse billing consultant can help. 

Rehab Centers vs. Insurance Companies

There is always an ongoing battle between rehab centers and insurance companies. Generally, rehab centers are paid via insurance money for the patients. A patient rarely pays out of their own pocket. 

But getting the money from insurance companies is no less than a headache. Reimbursement is often very difficult for rehab centers and other similar healthcare services. Moreover, some insurance companies send the reimbursement directly to the patients rather than to the healthcare facility. 

Even when they send the money to the healthcare company, there are many hurdles along the way of receiving money. To start with, insurance companies delay payments without specifying a reason. Furthermore, the billing process is complex. Mistakes in billing can cost rehab centers a lot more than they can earn. Some rehab facilities even ran out of business because of this particular reason. But if you hire a third party for billing, you can get the payments in time. 

Rather than opting for in-house or incompetent third-party billing companies, rehab centers must hire a reliable billing company with in-depth knowledge about billing procedures. Simply knowing the codes isn’t enough to create bills. 

Reasons for Rejected Claims and Delayed Reimbursement

Here are some of the main reasons why insurance companies reject claims or delay reimbursement to rehab facilities: 

False Claims and Caution Against Fraudulent Acts

Many healthcare facilities made false claims to get insurance money in the past. That’s why a lot of insurance providers are cautious of fraudulent claims. This is one of the biggest reasons insurance claims are either rejected, or the reimbursement is delayed. 

But effective billing can help get detox centers and rehab facilities their rightful money in time. 

Lack of In-Depth Knowledge

Another reason for delayed reimbursement is that billers don’t have enough knowledge. This can happen more commonly with in-house billing systems. It’s important to address the receivables of the last 90 days if you want to get your money quickly. 

Lack of knowledge on how to get past money can make it lost forever. But if your third-party billing company knows how to tackle lost money, they might be able to get you your money very easily. 

Reevaluation of Service Providers

Another reason rehab facilities and detox centers fail to get their money is that they don’t bother reevaluating their service providers. Reevaluation will help you understand whether or not a service provider is beneficial to your business. If it’s not, you should seek a new service provider. This is important for regaining your money. But this is one of the most overlooked factors. 

Payments Made to Patients

Many healthcare workers fail to realize that the money would be paid to the client directly. Before you take on a client, it’s important to understand how and who the insurance company will pay the reimbursement. When a rehab facility finds out, there is no way to get the lost money back. Often, many rehab facilities are left with millions of unclaimed dollars. For one reason, these unclaimed dollars remain lost, and rehab facilities fail to recoup the lost money. 

The Bottom Line

The bottom line is to have in-depth knowledge about substance abuse billing. A competent substance abuse billing consultant can guide you and even save your rehab facility from shutting down permanently. 

Some laws have mandated sending the payments to healthcare facilities rather than paying the patients in some states. If you’re not aware of all the codes, regulations, and tactics for getting the payment yourself, you should forget about in-house billing. Instead, you should hire a third-party substance abuse billing company that can do the job for you. 

Get in touch with Integrity Billing by calling (800) 683-5640 or visit Congress Professional II 1630 South Congress Ave., Suite 102, Palm Springs, FL 33461 for further details. 

Utilization Management Palm Springs, FL| Utilization Management Service

The Role of Utilization Management in a Healthcare Facility

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When you need to ensure your health care services are cost-efficient and compliant, you must clearly understand the process of utilization management (UM). Many changes have been made in the healthcare industry, but UM should still be an essential part of your management program. This complex process will improve the quality of your services, the health of your patients, the satisfaction of your employees, and reduce costs.

What Is UM?

As you may already know, UM is a complex but necessary process that ensures patients receive the best possible care, without unnecessary tests and costs. A good team can evaluate the value of the treatment each patient receives, lower costs, reduce denials, and improve patient care. Having the right team on your side can also ensure compliance and increase efficiency among your staff. A strong team is exactly what you will get when you contact Integrity Billing. We understand the true nature of your operation. Our background includes behavioral health, medicine, surgery, and chiropractic care.

In greater detail, here are just a few ways our team can help yours.

Reduce Healthcare Costs

With the increasing rise of healthcare costs, teams are looking for ways to save money without sacrificing patient care. Lowering costs can come in multiple forms. Our management program is thorough when it comes to saving your medical organization money. We will review all claims and services that patients receive to ensure they are medically necessary, which will also reduce claim denials.

Better Adherence to Regulations

As a healthcare organization, your team must adhere to multiple regulations. A comprehensive utilization review plan will help you stay compliant with all regulations. A utilization review plan is a requirement by the Centers for Medicare and Medicaid Services (CMS), so if your organization participates in these programs, we will make sure your review plan meets all the necessary requirements.

Reduce Denials

A UM staff is essential for reducing the number of denied claims in several ways. They can:

  • Review medical cases and provide modifications when necessary
  • Ensure proper documentation to prevent missing or incomplete information
  • Evaluate and approve treatments that will receive fewer denied claims

Improve Patient Care

No patient wants to pay for unnecessary treatment or treatment that simply does not work. The UM team is critical in this aspect, as well, because they review the best possible results of individual treatments and whether they are the best option for the patient. As any professional in the healthcare industry knows, finding the right treatment for their patient will yield positive patient results.

Comprehensive UM Programs Matter

There are a few types of UM and each one is necessary for healthcare quality. Reviewing treatments for effectiveness is an important goal of an efficient UM team. For this and many other reasons, a properly managed team can benefit the patient, the medical staff, and the insurance provider.

Contact Integrity Billing

Our goal is to address the needs of medical facilities so you and your staff can focus on patient care. We are committed to protecting your business revenue by working beyond traditional billing throughout the billing and collections process. Depend on us for better revenue management. Contact Integrity Billing or call (866) 413-1559.

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What Is a Substance Abuse Billing Consultant?

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Substance abuse is often called drug abuse. It’s a pattern of drug use that disables people from meeting their schedules. It can lead to significant problems such as driving under the influence and addiction. Substance abuse has significant effects on the social, mental, and financial health of individuals involved. Substance abuse can be of any type. The most common substance abuse is that of alcohol. Other addictive substances include meth, cocaine, and heroin. 

The exact cause of substance abuse is unknown. However, most often, two reasons are cited. One is a genetic predisposition that occurs from being around people constantly abusing drugs. The other is a habit that can transform from addiction into a profoundly debilitating disease.

Substance abuse also requires access to a substance, which you generally get in exchange for money. It’s no surprise then, many people with substance abuse issues also have a debilitating bank account. Here’s where substance abuse billing consultants come in. 

What Is a Substance Abuse Billing Consultant? 

Substance Abuse Billing consultants are people who help you manage your money while you’re in a rehabilitation center. It goes without saying that if someone is an avid drug user. At some point, they will decide to get clean. Once they make that decision, they must check into a rehabilitation clinic for at least 14 days. However, rehabilitation centers are not cheap, leading people to hire a substance abuse billing consultant. 

These people help you manage your finances in rehab and outside of it. They care for conditions set by your health care provider so you can get insurance for your substance abuse instead of paying it out of your pocket. 

Substance abuse billing is a complicated process, and any mistake can be costly. Substance abuse billing triggers rehabilitation centers for drug and alcohol addiction to battle insurance companies for reimbursements. The presence of a substance abuse billing consultant and third-party billing companies leads to maximizing results and getting payments quickly. 

It’s also important to note that any health insurance claim by these rehabilitation centers is often not responded, in time. Thus, the health insurance claims can get overwhelming for the rehabilitation centers.  There’s also a lot of mismanagement by insurance companies, who sometimes send the insurance directly to the patient instead of the rehabilitation center. 

Why Do You Need a Substance Abuse Billing Consultant? 

Rehabilitation centers also hire substance abuse billing consultants to ensure they get the money they need on time. It’s essential to overcome the system’s difficulty and ensure that rehabilitation centers are not overwhelmed due to a lack of management. 

The administration department in rehabilitation centers already has a lot of problems to deal with involving the health of their patients. Hunting down insurance companies shouldn’t be another item on their list. 

It’s important to note that many problems are fixable if you have the correct billing consultant to turn to. You need substance abuse billing consultants who have deep knowledge of the insurance companies they’re up against. If substance abuse billing is done incorrectly, it can cause several financial problems for the person and especially for rehab facilities. Similarly, hiring the right substance abuse billing consultant can get you the receivables on time and without much hassle.

You require a substance abuse consultant because they have training on how to talk to insurance companies. They know the ins and outs of legislature around health insurance, and it’s their job to understand the insurance company’s policy. Getting the insurance money becomes their job, and this delegation of responsibility eases matters on your end as an individual or even a rehabilitation center. 

A good substance abuse consultant will take time to create relations with the insurance companies that their clients are dealing with. This camaraderie leads to insurance companies paying up on time and without difficulty. 

Final Thoughts

Substance abuse billing consultants are necessary for people handling matters related to substance abuse. These consultants work for their clients, including individuals and rehabilitation centers for drugs and alcohol. They play a significant role in the fabric of society because, without such consultants, rehabilitation centers run the risk of going bankrupt. 

A facility or individual may not have the expertise to get their receivables from their health insurance company. However, a substance abuse billing consultant makes this responsibility their own and helps. They’re better equipped to do this, thus can do so efficiently. 

Integrity Billing offers a wide variety of services to those in behavioral health, medicine, surgery, and chiropractic services, including billing services. They have the expertise and experience to help facilities receive their reimbursements so they can focus on patient care. For more information on substance abuse billing consultants, visit www.integritybillingco.com or call (561) 355-5640.

A Day in the Life of a Collector

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A collector employed by Integrity Billing Company is a tenacious, insightful, detail-oriented, and persistent individual. Jane works at Integrity Billing; arriving at 8:30 in the morning ready to work. She immediately checks in with the Benefits department to offer assistance to an abundance of Verification of Benefits (VOB) requests. After she wraps up her VOBs, she immediately begins reviewing that morning’s EFT payments issued by major insurance companies, Medicaid, Medicare, and others.

Carefully examining as she posts, Jane searches for inconsistencies or discrepancies, taking note of any claims that need to be addressed. Sure, a computer could enter the payments and save her time, but at Integrity Billing, we appeal every inconsistent payment, regardless of the reason:  an incorrect deductible or coinsurance, a low payment, a short payment, or any other type of insurance payer error.  Jane is a member of the Integrity Billing team for her critical thinking. Jane is a member of the elite team of lead collectors at Integrity Billing.

Next Jane pulls a report of all claims outstanding, organizing and prioritizing the order she’ll work them. While on the phone with various insurance companies Jane works as a human lie detector, knowing exactly when to challenge the information she is being given by the health plan representative. She also knows when requesting a supervisor is appropriate. Jane spends her day advocating from the provider’s stance.  Armed with the information the health plan provided she then measures the situation, choosing the most effective way to solve the puzzle; whether it be submitting a corrected claim, writing an appeal, or continuing to verbally dispute the issue with her adversary. These intricate measures are some of the few actions Jane takes to ensure that the provider is receiving accurate payment for the services they provided. This is only a fraction of what makes Jane, and the other collectors at Integrity Billing the crème de’ le’ crème of behavioral health collectors.

Not everyone has what it takes to be a Behavioral Health / Mental Health elite collector. One needs to have the ability to remain resilient so one can continue to push forward despite barriers. One needs to be calculated and deliberate, so that a strong and unshakable case can be presented to the opposing side.  Lastly, one needs to be creative, abstract, and able to gauge a situation; so that the problem can be approached from a different perspective when previous efforts fail. These attributes and talents are not possessed by many.  This is strategic daily planning. That’s why the collectors at Integrity Billing are considered Elite.

Without question, if I were a Substance Use Disorder or Mental Health services treatment facility owner, I would want Jane or another “Jane” from the team of elite collectors at Integrity Billing to handle my collections. These are the type of professionals that I would want on my team.

Having seasoned collectors that stand head and shoulders above the rest is one of the many factors Integrity Billing prides itself on. It is a tremendous contributor to what distinguishes us from other revenue cycle management companies and one of the driving forces behind our “Expect More” tagline.

 

Sean McDonald

Road to Becoming a Successful Leader

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As I evolve personally and professionally, I find myself seeking out opportunities to learn more about leadership. Working in Billing and Collections for behavioral health providers of Substance Abuse Disorders and Mental Health facilities, I will always work on my skills and knowledge; however, learning a technical skill in Revenue Cycle Management is vastly different then learning how to be a great leader.

I have decided to write a blog about leadership so I could become a respected leader. One of the aspects of being a great leader is you must be knowledgeable in the line of work you choose to be a part of. You must be dedicated and committed to your team. It is essential to have considerable communication skills, the ability to approach and establish an understanding of the mindset of your team.

A great leader should have the ability to support and guide the team to success. Leaders must be able to motivate, delegate, listen, make decisions and problem solve. Integrity is one of the most important things to convey to your team as leader, integrity is regarded as the honesty, truthfulness, and accuracy of one’s actions. I cannot express how crucial it is to have strong ethical or moral principles.

Leadership is an ongoing process to broaden and differentiate one’s capabilities required to perform effectively. As I develop myself into becoming the best leader I can be, I find one of the key aspects is attitude. Great leaders should influence their team towards their goals. In my experience a great leader is not about being the smartest, but it is more about understanding others and what makes a team work together to reach solutions.

Setting clear expectations is extremely important. In order for a team to succeed, they have to understand what is expected of them, and what their goals is. When expectations are clear the team bears the proper skills, knowledge, and resources to complete the task at hand. They are more likely to show accountability for the work they are preforming. As a leader it is very important to have team meetings to review and discuss the progress, trends and to ensure the team is meeting their individual and team goals.

Learn to motivate through recognition by giving feedback, new responsibilities, encouraging productivity, setting effective goals and team building. Anytime I find that feedback or assignments are not received well I immediately make a mental note to provide more encouragement. In my experience the more I give feedback and encouragement, the easier it is received.

Overall, leading a team is extremely challenging at times, however, it is very rewarding. We have worked hard to create an environment of integrity and transparency. Effective leadership requires fluidity to help deal with each situation on an individual basis. Mastering this provides us with the strongest chance of leading the team to success. We strive to be the best of the best, and with this mindset the leaders of Integrity Billing will guide our organization into a prosperous future.

“LEADERSHIP IS NOT ABOUT TITLES, POSTITIONS OR FLOWCHARTS. IT IS ABOUT ONE LIFE INFLUENCING ANOTHER,” — John C. Maxwell

SUD Billing Wellington, FL

Expect more from Us – A Utilization Rant

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Working in the behavioral health revenue cycle management field behind the scenes performing utilization review and utilization management, advocating for those struggling with Substance Use Disorder and Mental Health Disorders has its challenges.

I chose to write this for its therapeutic value; although I do hope to get the attention of my colleagues to see if they are experiencing some of the same frustrations I do.  I have often thought of creating a supportive blog or platform where Utilization Review Professionals can share dissatisfactions, disappointments and exasperations over what are sometimes jaw dropping denials for patients struggling with potentially deadly issues.  It could also be a forum to discuss successes, as we know there are many of those as well.

Baffling are comments such as “we know this case, multiple treatment attempts- they will be fine in intensive outpatient” and “don’t expect a long length of stay, she is young she will bounce back. “   And my all-time outlandish award goes to “expect a step down at next review” – have you ever heard this and thought to yourself, “but I haven’t even provided the clinical for this review, how are you able to future trip my step down?”

These comments coupled with the denial letters received after a Peer Review make for further fodder. I do hope everyone is reading them. Personally, I can hardly recognize the clinical that was pulled out of conversations and used as rationale to deny a level of care. In most cases the information cited in the denial letter does not remotely represent the clinical information that was relayed to the doctor and it scarcely resembles any clinical documentation in the patient chart.

I often wonder if the physicians and clinicians at the insurance companies understand that comments such as “he is not homeless; he can sleep in his car” or “she is able to function day to day” after the patient attempted suicide the previous day, is homeless and also experiencing paranoid thoughts, could be considered discriminatory and stigma – possibly at its worst? That their oath to “do no harm” applies whether they are working in an office or working for an insurance company.

As I express my frustration, I would also like to convey that no matter what obstacle we face, an arrogant physician, a cranky care manager, a lax insurance payer, an indignant supervisor, we can’t give up on trying again and again and yet again to help those that are currently unable to help themselves. And further, we must always “Expect More” from those who can.

Although exhausted, we must pursue integrity. That takes stamina and the willingness to never give up. Our company tag line is “Expect More” – we never fall short of that; we give much more, that I can say with certainty.  We love what we do, we do what we love. We believe, that if you do not believe that a patient can get well and turn their life around then this is not work that you will be happy to do. I hope to see the day that the care managers of the insurance payers demonstrate the same belief.

At Integrity Billing, we celebrate victories such as overturned denials and appeals by ringing a bell every time those claims pay.  These are the types of things that make our day. Therefore, we are here.

Expect More.

Utilization Management Palm Springs, FL| Utilization Management Service

Five tips for keeping a neat work journal.

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My thoughts are constantly scattered. Having a broad range of work duties can make it difficult to keep track of responsibilities. At times, intense focus on a single task can cause a loss of sight for tasks that seem unrelated. I have kept a work journal for the past few years. It has helped me immensely. However, I have learned a few things along the way. Here are five tips for keeping a work journal.

Handwrite your notes. Scientific studies have shown handwriting notes can help you retain the information better.  Most people can type faster than they can write something out by hand. The ability to type notes verbatim ends up being a detriment. Handwriting, being slower, forces people to actively think about the information and decide which parts are important. This active process makes it more likely that the information will be retained.

Start a new page every day and do not forget the date.  I rarely reference my notes more than a week back. However, on the rare occasions I cannot remember the status of a task, having a record and date of completion will alleviate self-doubt.

At the beginning of each day start a new task list to prioritize your goals. Allowing yourself ten minutes in the beginning of the day will help you decide which items on your task list are most important. It can also help you block off your time efficiently.

When you do something that was not on your task list, write it down just to cross it off. Not only is this an extremely satisfying symbolic gesture, but it is also good to have it as a reference in the future.

Break large tasks into their smallest possible pieces. It will help you be more productive. Large goals can be overwhelming and time consuming. It is much easier to block off time for four several smaller tasks than for one large task.