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At first glance, both claim denial and claim rejection can seem the same exact thing. Many practitioners use the term interchangeably. We are here to tell you how to grave a mistake that can be. This ostensibly simple misunderstanding can be detrimental to your practice and push your revenue cycle into disarray. It is extremely imperative to understand the differences between these two terms if you are to stabilize your practices cash flows.

The Difference

Claim Denial

Claim denial can be defined as claims that were received and processed by the insurance companies, but a negative determination was made. You simply cannot resubmit such claims; they need to be researched to understand why this particular claim was denied and then write an appropriate appeal for its resubmission. If this claim is resubmitted without an appeal, then the chances are that it will be rejected as a duplicate, thus costing you more time and money.

Claim rejection

Claim rejection is altogether a different concept. These are claims that do not meet specific data requirements or are formatted inappropriately, which ultimately resulted in their rejection. These medical claims cannot be processed as they were never received by the insurance companies and entered into their computer database. This type of claims can be easily resubmitted if the errors are rectified. The errors can be as simple as a missing alphabet in the name or a transposed digit from the patient’s user I.D

The Reason for Denial and Rejection of Claims

There are 5 major reasons for medical claim rejections, and they are as follows:

• •     Missing information, for e.g. missing address, pin code or phone number.
• •     Duplicate claim for service – claims that were mistakenly submitted more than once
• •     Service is already adjudicated
• •     Service is not covered by the payer
• •     The limit for filing has expired

Improving claim rejection and denial rates

Whether you are someone who has a dedicated in-house staff, or outsourced coding and billing to a third-party service provider, you need to follow some crucial steps to ensure your claims aren’t rejected or denied.

• •     Track and analyze patterns in payer denial and rejections. Once you have categorized these denials and rejections, you can devise a strategy to cut their rates.
• •     Train your billing staff on how to handle claim denials appropriately.
• •     Schedule routine audits to identify problems before claims are sent to the payer.
• •     Work with payers to avoid denials by discussing, revising and eliminating contract requirements.
• •     Use billing software or hire a vendor to take care of claim denial and rejections efficiently.

The Bottom Line

Claim denials and rejections are some of the most prevalent challenges that practitioners face today. A lot of care needs to be taken to avoid denial and rejections. Thankfully, we at Denmaar are here to clear the air surrounding medical billing and help you submit strong claims that have very low chances of denial and rejection.

Here at Denmaar, we partner with concerned practitioners to offer pre-authorization, third party billing, claims follow-up, and to assist with appeals for any denied insurance claims. With Denmaar, you get the assistance of our behavioural health billing specialists to make your billing process easier than ever.  

Medical billing can be a crucial, but complicated process. It constitutes one of the most vital components of the health care industry, especially the behavioral healthcare sector. What makes the behavioral medical billing process concerning is the frequent billing errors that are pervasive throughout the industry.

Errors in coding are frequent sights to witness, especially when it comes to behavioral health, as such the diagnosis, treatment and coverage for a patient can be extremely messy. This, in turn, makes the claim submission process messy, resulting in most cases with denial of the claim.

Prominent Billing Errors

If we have any chance of combatting the issue of billing, we must first try to understand its cause. Some of the most common errors are listed below.

Clerical Errors

Errors such as incorrect spellings, typos in insurance ID’s are a major reason for insurance firms denying claims. The name, contact, and address of both the provider and insurance company could be entered incorrectly. This is because the medical bills can be influenced and changed by dozens of people, hence such errors are common

Outdated Information

Apart from incorrect information, outdated or obsolete information can also put a wrench in your claim approval ambitions. Outdated information may come from the patient themselves. Claims can be rejected if data is found to be outdated; hence keeping data up-to-date is crucial.

Incorrect Quantities

An incorrectly entered quantity can end up charging the patient extra. Even erroneously adding a zero at the end of a number might widely exaggerate the cost of the treatment. Such errors should be avoided at all costs.

Messy Documentation

Most physicians have illegible handwriting. At this point, this has developed into a cliché amongst various medical professionals. However, this can also result in claim rejections as the handwritten documents are simply too messy to be comprehensive.

Double Billing

Double billing, unfortunately, is a common Behavioral medical billing mistake that has been going on since time immemorial. A patient might be charged twice, once by the doctor and once by a nurse who wasn’t aware of the doctor’s actions. A patient might also be charged twice for both drugs prescribed and drugs administered.

Undercoding

Undercoding occurs when the act of behavioral medical billing for a service is less expensive than the treatment provided, or leaving out codes altogether. Patients might be undercoded by providers to minimize patient’s costs or avoid any audits. Unlike other errors, this error affects the provider more than the patients.

Upcoding

Upcoding occurs when the act of billing for a service is more expensive than the treatment provided. This happens when a billing code is incorrectly changed to represent a more severe treatment or diagnosis. Upcoding has been deemed illegal and can also inflate a medical bill.

Incorrect or Mismatched Codes
Incorrect or mismatched codes can occur when a provider upcodes a patient’s diagnosis without changing his billing code. Mismatched codes can also inflate claims due to upcoding.

Unbundling

Unbundling is an act of billing for individual services that can be covered under a less expensive treatment plan. This basically means that charges which were typically falling under one code are now being listed separately.

Best Practices to Avoid Billing Errors

With the above causes now crystal clear, let’s look at some of the best practices that can help you avoid billing errors, and thus prevent claim rejections.

• •     Double Check Patient’s Personal Information
  This is probably one of the easiest ways to avoid medical billing errors-simply verify and re-verify your patient’s personal information. Make sure all the information submitted by them is correct and devoid of any silly mistakes and omissions.
• •     Double Check  Patient’s Insurance Information
  Make sure to call your patient’s insurance company before you provide them with your services. Check whether their policy number and coverage are the same and that you have updated billing contact information.
• •     Establish a policy to compile billing information
  Establish a clear and precise policy that communicates accurately how billing information needs to be handled and managed by your staff. You have to ensure your patients aren’t being charged twice, hence make one person-in-charge of monitoring and managing the staff that handles billing.
• •     Follow up on your claims
  You can avoid errors by simply being diligent in your follow-ups with insurance companies. A representative working on your claim might be able to inform you of errors, allowing you to rectify and re-submit a polished claim again.
• •     Establish Clear Communication and Co-ordination
  Everyone working on a claim in your staff should be well aware of their roles and responsibilities. They should also be well organized and coordinated to know how to communicate with each other effectively. Stay up-to-date It is crucial that you stay up-to-date with your claim process and avoid the entry of any kind of obsolete information from your documentation.

DENmaar’s Mental Health Medical Billing Service

As you can guess from the article, behavioral health medical billing is not a walk in the park. A lot of effort, blood, and sweat goes into the entire process. It can be time-consuming and really frustrating for mental health practitioners who just want to tend to their client’s needs.

Here at DENmaar, we partner with concerned practitioners to offer pre-authorization, third party billing, claims follow-up, and to assist with appeals for any denied insurance claims. With DENmaar, you get the assistance of our behavioral health billing specialists to make your billing process easier than ever.

Behavioral medical billing is one thing that mental health practitioners simply wish to do away with. It is a special kind of frustration that is conjured when you try to file insurance claims for mental and behavioral health benefits.

Due to the types of services offered, or the pre-authorization needed, the challenges that mental health practitioners face are unlike any their contemporaries have to deal with.

What Makes Mental Health Billing so Complicated?

Lack of a standardized process as compared to other practices would be a simple answer to this question. In a Behavioral health practice, there are a number of variants when it comes to types of services offered. Major time in behavioral healthcare is spent on therapy sessions. Insurance companies take note of how long the duration of these treatments can go for, as well as how many of these sessions can take place in a day. Both counselors and psychiatrists simply have a very different way of dispensing their services.

These make it very difficult for them to balance their treatments with an adequate billing system. Another area that clearly distinguishes mental health billing from other conventional billing plans is the fact that the problems with behavioral medical billing are only amplified by office budgets.

Counselors will often try to process their own bills, to cut down on operation costs for their private practices. The lack of dedicated staff to update billing codes for behavioral health, changing regulations, and billing practices for each of the respective insurance companies, will result in rejection rates skyrocketing.

If you want to process your claims quicker, then the following can help:

File within the time allotted by the insurance company
Use only the billing format required by your client’s insurance company
Use the appropriate code for the delivered treatment
Limit the bill’s total to the fee allowed by your client’s insurance policy
Use the appropriate policy number for the bill claim
Submit the claim to the right address
Receive pre-approval for treatment as needed by the insurance plan

On average, only 85 percent of claims for behavioral healthcare is approved. Improving these approval rates is the biggest challenge facing behavioral healthcare providers today.

Make it a habit to double-check your client’s insurance plan before each and every visit. Sudden policy changes and lapses in coverage are common in the world of health insurance. Try to stay ahead of the game for your own benefit.

Be up-to-date on each of your client’s insurance company filing methods. Paper and fax have become a thing of the past, and are now being replaced by email, and online filing services. Stay in touch with the insurance companies, as you don’t know when they will change their billing method.

DENmaar’s Behavioral Health Medical Billing Services.

As you can guess from the article, medical billing for mental health is not a walk in the park. A lot of effort, blood, and sweat goes into the entire process. It can be time-consuming and really frustrating for mental health practitioners who just want to tend to their client’s needs.

Here at DENmaar, we partner with concerned practitioners to offer pre-authorization, third party billing, claims follow-up, and to assist with appeals for any denied insurance claims. With DENmaar, you get the assistance of our behavioral medical billing consultants to make your billing process easier than ever.