The fast pace of the medical office is the ideal environment for billing errors. Patients are showing up in 15 minute intervals, the phones are constantly ringing and not to mention several walk-ins have shown up and your office staff is doing the best they can to still offer excellent customer service.
As with anything else, when times are chaotic, something will slip through the cracks or an error will be made. No matter how much you express the importance of accuracy to your medical office staff, you can’t just stop there.
Assuming that your medical claims are being billed error free is the surest way to getting denials and delayed payments. Incorporating a chart audit process in your day to day operations could be the difference between being paid as early as 10 to 14 days instead of 45 days.
The simplest way to audit charts is by creating a checklist. Be sure to include information that could cause denials or delay payments. Simple inaccuracies can make a big difference.
- Is the patient’s name spelled correctly?
- Is the patient’s date of birth and sex correct?
- Is the correct insurance payer entered?
- Is the policy number valid?
- Does the claim require a group number to be entered?
- Is the patient relationship status to the insured is accurate?
- Does the diagnosis code correspond with the procedure performed?
- Does the procedure code performed match the authorization obtained?
- For multiple insurances, is the primary insurance accurate for coordination of benefits?
- Is the Physician NPI number on the claim?
Also be sure to review your denials. Use it as a tool to educate employees. Most likely they don’t know they are doing anything wrong if you continue to see the same trends. Make a spreadsheet of your most common denial reasons and use that as your guide to creating a checklist.