Technology Alone
Doesn't Get Claims Paid.
Knowledge Does

The recent novel coronavirus outbreak has cemented the fundamental nature of Telehealth in our health care system. It has quickly proven to be a lifesaving innovation in health care technology and many providers are making sure they facilitate their patients with TeleHealth services for continued, safe provision of health care.

The federal government has already expanded on the concept of TeleHealth services, deeming it to be the perfect tool in the face of COVID – 19. Tele-Health succeeds in the practice of healthcare provision by implementing the principals of social distancing and isolation, both of which are important to decimate the super contagious virus. 

Telehealth provides patients with the tool to consult with their doctors from the comfort of their respective abodes. It allows for face to face communication without compromising on the concept of physical distancing. 

Apart from social distancing, TELEHEALTH also offers the following benefits to both providers and patients.

The Benefits of Telehealth include:

• •     Making Healthcare accessible for rural and isolated communities.
• •     Access to behavioral and other medical specialists
• •     Making services available for communities and people with limited mobility, or transportation options
• •     Improved communication between doctors and patients
• •     Improved self-management of health care practice

For many traditional health care professionals, Telehealth is still uncharted territory. Venturing into something this unknown to them can seem intimidating. However, most TeleHealth services today are easy to use and can be implemented with only minor level training.

As of now, there are no legal certifications required by practitioners to provide TeleHealth services to their clients. However, there are many professional behavioral health associations that demand some level of competence in the part of providers to better implement the new service. 

As some states are relaxing licensing requirements, that is not the case with all states. Be sure to check with your local licensing boards on the formalities and rules that apply to your practice. Make sure that telehealth and cross-state services are covered under your policy before rendering the service.

DENmaar’s TeleHealth Services

At DENmaar, our telehealth solution offers both patients and providers with a communication technology that allows the access and management of health care services from homes of patients or the practices of doctors.  This teleconferencing feature allows practitioners to attend to their patients, on their computer screens, where-in they can consult and serve their clients without having to make them wait in their clinics or making them transit long distances. 

All you have to do to access our feature, whether you are a provider or patient, is to sign up to our app and avail our telepsych feature. 

Telehealth for Patients

Our telehealth feature offers patients with the following benefits

• •     Easy communication with doctors and nurses online
• •     Prescription refill requests
• •     Schedule appointments
• •     Review Test Results

Telehealth for Providers

• •     Counseling Patients Online
• •     Provide healthcare advice and services in remote and rural areas
• •     Schedule appointment or post-appointment reminders
• •     Review and deliver test results

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.