The goal of the medical biller is to ensure that the provider is properly reimbursed for their services. In the pursuit of this goal, errors, both human and
electronic, are unfortunately unavoidable. Since the process of medical billing involves two incredibly important elements (namely, health and money), it’s important to reduce as many of these errors as possible. In this brief course, we’ll introduce you to some common errors in the medical billing practice. Before we jump into that discussion, however, let’s review the difference between a rejected and denied claim. As you’ll recall from previous
Courses, a rejected claim is not the same as a denied one. A rejected claim is one that contains one or many errors found before the claim is processed. These errors prevent the insurance company from paying the bill as it is composed, and the rejected claim is returned to the biller in order to be corrected. A rejected claim may be the result of a clerical error, or it may come down to mismatched procedure and ICD codes. A rejected claim will be returned to the biller with an explanation of the
error. These claims are then corrected and resubmitted. Clearinghouses employ a process called “scrubbing” in order to avoid rejected claims. The end goal, for billers and clearinghouses, is a “clean” claim. Denied claims, on the other hand, are claims that the payer has processed and deemed unpayable. These claims may violate the terms of the payer-patient contract, or they may just contain some sort of vital error that was only caught after processing. Payers will include an
explanation for why a claim is denied when they send the denied claim back to the biller. Many times, these claims can be appealed and sent back to the payer for processing, but this process can be time-consuming and, therefore, costly. For that reason, it’s important to try and get as many claims “clean” on the first go, and not waste any time billing for procedures that are incompatible with a patient’s coverage. Simple ErrorsNow that we’ve reviewed denied and rejected claims, let’s look at some of the basic errors that can get a claim returned to the biller.
Like medical coding, we’re always striving for the highest level of accuracy in our codes, and we’re also required to provide as complete a picture as possible of the medical procedure(s). If you can cut down on these simple errors in your medical billing, you’ll have a much higher number of clean claims. More Billing ErrorsThe above are some of the most frequent errors a medical biller comes across. These errors directly affect the status of a claim, which makes them very important to watch out for. But there are other errors to watch out for as you go through your day as a medical biller. Some of these are, regrettably, out of the biller’s hands, but they’re important to watch out for nonetheless.
Fixing Errors Before They HappenIt’s always important to be proactive when you’re medical billing. Here are a few of things you can do to catch medical billing errors before they happen.
Jump to a Different Section:Which are unpaid claims that have been returned to the provider?Denied and rejected claims are unpaid claims that have been returned to the provider by third-party payers. Which is an example of a reason for denied claims? Which is the term for the reason for a denied or rejected claim as reported on the remittance advice or explanation of benefits?
Which type of claim includes those that were rejected due to an error or omission and need to be processed?Health Ins. Chapter 4. When a third party payer identifies an error on the claim form the claim is quizlet?When claim form errors are identified by the third-party payers,the claim is then rejected. Which of the following is not considered an error? The primary insurance information will be placed in _______ of the CMS-1500 form for secondary billing.
What is a third party payer quizlet?Third Party Payer. Private or government organization that insures or pays for health care on behalf of beneficiaries.
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