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5 Common Reasons Your Claims are Bouncing Back

Billing is a complex and often tedious procedure, especially with ICD-10 codes. However, the reasons for returned and delayed claims often boil down to a few basics. Here are some of the most common billing mistakes practices make, and how to make sure your practice avoids them.

  1. Little Typos, Big Headaches

    Often reimbursements are delayed or denied because of very small, easy-to-make mistakes. “When I was assistant director of billing for a large multi-specialty practice,” says Brennan Cantrell, “the front office would often transpose the numbers or letters in policy number or omit a group number or plan ID. The front desk is extremely busy, and these are easy mistakes to make.” Cantrell, who is now commercial health insurance strategist for the American Academy of Family Physicians, says that the ideal solution is having an employee dedicated to watching for and correcting these errors. For small practices, this may not be a full-time employee, and the time saved by not having to resubmit claims might offset the time spent rooting out mistakes.

  2. Something’s Missing Here

    Sometimes payers delay payment because you didn’t send enough information. Often you can see this coming. “For example, when you file workers’ compensation claims, you will always need to submit documentation with the claim,” says Tammie Olson of Management Resource Group, an Ocean Springs, Miss., a firm offering financial management and support services for the healthcare community. “If you know you need to send the documentation to get a claim paid, do so when you file.”

  3. Please Ask First

    Another incredibly easy—but costly—mistake is not getting prior authorization. “Before you perform procedures, make sure you verify whether or not a prior authorization is required,” says Olson. “If it is, send in the request before scheduling the procedure.” And when you get ready to bill the procedure, “make sure the authorization number is on the claim,” she adds. Prior authorizations can be a pain, but having a routine for them when they are necessary can save time and prevent payment delays.

  4. Let Me See that One More Time

    Claims are increasingly denied because the patient’s coverage has been terminated or the plan or payer has changed.  Most of the time everything is just as it was the last time the patient came in but you should still ask to see the patient’s insurance card at every encounter. “People change insurance plans more often than they used to,” says Cantrell. “It’s a simple thing, but important.” Olson agrees, and adds, “If you do this, you should never have a claim denied for “policy terminated.”

  5. Keep up with the Changes

    Even when policies haven’t changed, what is and is not covered on a given plan sometimes does. You can be left holding the bag if a payer changes its policies about what procedures they cover or what labs they use, and you don’t hear about it. “Most payers send out a policy bulletin announcing these changes,” says Cantrell, “but it’s difficult to find time to keep up with this.” Large practices often have administrators who watch for these changes and pass the word on to each billing office. However, in smaller practices that job may fall to the front desk or billing staff. Make sure whoever does this understands the importance of carefully reviewing these bulletins when they are issued.


By: Avery Hurt

Ms. Hurt is a freelance writer based in Birmingham, Ala. Her work has appeared in publications including Newsweek, The New Physician, Muse, Parents, USA Today, and the Washington Post

New Medicare Cards are in the Mailbox

new Medicare card

Last June’s post was about new Medicare cards.  At the time of the post, it seemed like a long time away and something that could be pushed off until a later time.  Well, that time is upon us.  Beginning next month, the federal government will begin issuing new Medicare cards.  Gone are the days of using the patient’s Social Security numbers as their ID numbers.  The new Medicare cards will have unique, randomly assigned numbers and letters that replace Social Security numbers.  The new Medicare cards are being mailed in waves beginning April 1 and continuing through April 2019.

What the new Medicare cards mean to your practice

This is good news and bad news for all medical practices.  The good news is that the old cards will work until December 31, 2019.  The bad news is this means the front office staff has to wade through this transition for 21 months!  Health care providers must use the new card numbers beginning January 2020.  Some practices may think they can put this off but this time the patients are likely to force the transition.

This change will undoubtedly result in some of your patients having questions and concerns   The Centers for Medicare & Medicaid Services is encouraging Medicare patients to bring their new card to their next visit.  They are informing seniors that the change in cards is to protect them from medical identity theft.  CMS is also informing patients that if they forget their card then their health care provider can look it up for them.  If patients are also in a Medicare Advantage plan then the Medicare Advantage card is the main card for Medicare.  However, it is better to be safe than sorry so make sure you add the new card to the patient’s record, as well.

Cloud or Server – What’s right for my practice?

Cloud based Server

Every private practice health care provider has had to weigh and measure whether a cloud-based or server-based software solution is right for their practice.  As your practice grows, it is good business to assess whether your initial decision is still the right one.

A few months ago, one of our clients found themselves in the path of a raging fire.  Fortunately, they had made the decision to be cloud-based.  Initially, they had to access patient notes via a tablet and then utilized a temporary office to see patients.  They never missed a beat.  All of the patient care data was completely backed-up and accessible from anywhere they were.

Cloud-based servers can be an attractive solution for many reasons.

  1. They provide on-going and instantaneous back-up systems;
  2. The back-up sites are in multiple locations throughout the United States so redundancy is in place;
  3. The responsibility and cost to maintain the cloud-based servers are not an expense the practice must bear;
  4. You do not have to worry about upgrading or maintaining the servers; and
  5. You save money because you do not need IT staff/contractors to manage, maintain or troubleshoot the servers.

Yet, there are those who feel a server-based solution is best for them because:

  1. They maintain direct control;
  2. They feel that troubleshooting response time is faster with in-house servers and contracted IT staff; and
  3. Despite the associated costs there is a level of trust in server-based over cloud-based.

Regardless of the solution you choose or have chosen for your practice it is important that you have a technology disaster plan.  No one plans on a disaster.  Most of us have never and will never experience one.  But, if there is one will you be able to access your patients’ records, refill prescriptions and DME orders and keep your practice going?  So, whether it is an extended power outage, hurricane, fire, earthquake, tornado or a flood you need to be prepared.  Is your data backed up off-site and out of your geographic area?  Will you be able to access the patient data if you have to practice in another location?  Could you function if all you had was an iPad or tablet?

Assess your situation and make changes as you deem appropriate.  Don’t wait until it is too late.
Server based


Three Ways to Increase Your Practice Collections

How much money is your practice losing?Increase Collections

Collections are the life-blood of your practice.  Yet, doctors in the United States lose roughly $125 billion per year due to poor billing practices.  According to an MGMA study, an average practice will recover just $15.77 for every $100 owed once a patient defaults on the amount they owe to you.

Below are some ways that can be implemented in order to maximize your collections. You will find that most are fairly easy and do not require additional resources.  They do require a concentrated effort but will prove to be financially beneficial.


  1. Make sure you have a patient portal.
  2. Remember, having a patient portal isn’t enough.  You must maximize your patient portal.
  3. Make sure you have an online bill payment option.


  1. Give patients a wide variety of options for paying their bills.  Be sure to accept cash, checks, credit cards and debit cards.
  2. Encourage patients to register a credit card to keep on file with your office and make sure they enroll in an automatic pay option for their patient balances.
  3. Encourage patients to pay past account balances and current charges at the time of service.
  4. Train all staff to firmly but gently communicate with patients about patient financial responsibility issues.
  5. Be willing to refuse service to patients who do not pay.


  1. When you transition to a billing company, you get trained specialists dedicated to medical billing.
  2. Outsourcing means you don’t have to worry about personnel issues, covering vacations or ongoing training expenses.
  3. Utilizing a billing company will afford you the benefits of state-of-the-art software, up-to-date processes and key reports in a timely fashion.
  4. Dedicated efforts, working every denial, and not accepting zero payments will result in your practice getting more money faster.

Maybe all three ways won’t work for your practice or maybe you’ve already done some and that is great.  Every way that you implement will only help to increase your practice collections.

How To Maximize the Patient Portal

maximize your patient portalCongratulations on getting a patient portal for your practice!  An August, 2015 study, published in Health Affairs, found that only 10.4 percent of practices met the meaningful use objectives of providing a patient portal.

This year, eligible providers who don’t meet the requirements for Meaningful Use, stage 2, will suffer the 1% Medicare penalty.  While stage 2 has 20 core objectives, two of the most challenging will likely be: 1) 50% of your patients must be able to access their health information online in a timely manner, and 2) more than 5% of patients must actually use the providers’ patient portals. This means that not only do your patients need to be enrolled in your patient portal, at least 5% need to actually be using it.

Just having a patient portal is not a build it and they will come venture.  You must be actively involved and your staff also has to be ready, willing and actively engaged in getting your patients to sign up.

Yes, patient portals can be great tools.  They can be very beneficial to your patients.  They can improved office workflow and save your staff time.  But, before you can realize these benefits you must actually get patients and staff to use it.  Here are some tried and true tips that other practices have used that will help maximize your patient portal in no time.


Your staff has a real opportunity to promote the patient portal at every patient interaction.  Educate the staff to see how the patient portal will improve their workflow.  When patients can make appointments, pay bills, and message their provider it means less phone calls to the office.  It also means that patients can complete the patient registration/check-in process faster.

A very busy orthopedic practice saw every patient interaction as a chance to promote the patient portal.  In the end, 25% of their patients were actively using the portal.  Here are some of the things this practice implemented.

  1. Every staff member had a script to ‘talk up’ the benefits of patient portal to patients;
  2. When patients called for an appointment, the staff reminded patients they could make their next appointment online;
  3. The practice utilized the appointment reminder feature to encourage patients to register for the patient portal;
  4. Staff reminded patients that they could pay their bills online;
  5. The practice engaged their billing company to help promote the patient portal both when talking to patients and by putting a message on the patient statements; and
  6. Before the physician left the exam room patients were reminded that they can access lab results, send secure messages or get other information relative to the practice.


Are you promoting the patient portal the right way?  Don’t tell patients about the features.  Instead, tell them how it benefits them.  Saying the portal has ‘secure messaging’ or an ‘appointment calendar’ isn’t enough.  Tell them they can communicate directly with you when it is convenient for them.  Or, you know their time is valuable too so now they don’t have to call the office, during office hours, or wait on the phone.

Every piece of marketing collateral must promote the patient portal.  Create a non-page handout, explaining the benefits and how to register.  It is important to give them clear instructions on how to register.  Have your staff try out the instructions so that you know you have covered every ‘how to’ step.  This will also ensure that staff knows how to explain it to patients.

Add it to your website; your automated appointment reminder; brochures,  and Facebook page, if you have one.  Also, the new patient packet offers a good opportunity to introduce the patient portal.


Don’t assume that your older patients won’t or can’t sign up for the patient portal.  Kaiser Permanente is the best example of effectively using their patient portal, My Health Manager, the largest private-sector patient portal in the United States.  In the third quarter of 2015, Kaiser had more than 5.2 million or 70 percent of adult members registered and actively using their patient portal.

Kaiser reports that the older patient was actually eager to register.  They appreciated the access to their healthcare providers, lab results, the ease of making their next appointment and make payments.

They may need a little extra help registering and navigating the patient portal but the time spent is well worth it.  Remember, it will ultimately cut down on time spent by your office staff.


Tracking the number of patients who are actively engaged with your portal will tell you what you are doing right and where you might make improvements.  They key to success is patient awareness.  Make sure both your staff and your patients know how to use it and that they understand how the portal benefits them.  Then watch your engagement numbers grow.  You will find that your office is more efficient, patient payments are collected faster, patients appreciate the increased interaction and you will meet Meaningful Use.  A win for all.

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