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Best Practices in Insurance Billing: 5 Tips to Set You Up for Success

It’s really no secret: accepting insurance benefits you and your patients. It gives your patients access to services they might not seek out otherwise, improves your online visibility, and offers other invaluable opportunities to build a thriving practice. But it also makes more work for your office – and many providers find themselves completely unprepared.

Don’t fall into the trap of insurance ignorance! We’ve compiled a short list of the best insurance billing practices to ensure your success. Enjoy!

1) Do Your Homework: Read your Insurance Contracts and Correspondence Carefully

Do you know how insurance works? If not, why would you ever sign a contract with an insurance carrier? It sounds crazy, but healthcare providers do it ALL. THE. TIME. As a result, they can’t make sense of their contracts or important correspondence sent by the carrier – if they read it at all.

Accepting insurance is a serious decision, so make sure you know what you’re getting into. When you sign contracts, pay special attention to fee schedules and contractual terms. Contract terms should outline mandatory discounts and any requirements the carrier has for address changes and other demographic updates. If you don’t understand something, call your Provider Relations rep (or if you’re an Acubiller client, ask our team!).

2) Check Patient Benefits & Coverage Thoroughly Using all the Resources Available to You

Insurance doesn’t cover everything. The services covered by an insurance policy are called benefits. Accurate benefits ensure accurate payments. Don’t rely on a patient’s understanding of their benefits. Instead, plan ahead and do your own research. Insurance company websites and Provider Services telephone lines often provide up-to-date benefit details and policy information. Familiarize yourself with and utilize these resources for the best results.

Remember, your patient is financially responsible for anything not covered on their policy, and treatment can be costly. A little preparation goes a long way in managing patient expectations. Check the front and back of your patient’s insurance ID cards for the most helpful website and phone number information.

Two popular resources for benefit and claim inquiries are Availity and Navinet. These websites provide policy information and claim status updates for major insurance carriers, including Blue Cross Blue Shield, United Healthcare, Aetna, and Cigna.

*Acubiller clients receive timely benefit verification for every patient as part of our comprehensive billing services.

3) Only Bill for Past and Current Visits (Read: Never future bill!)

Billing for services you have not yet performed is insurance fraud. Read that again. Then, read it again. Then, commit it to memory. We literally cannot stress this enough. Seriously, DON’T DO THIS. It happens WAY too often and it jeopardizes your career. Warn your colleagues!

4) Get Organized with Spreadsheets

Running a successful practice involves administrative work and data collection. Patient information, invoicing, overhead, carrier fee schedules, CPT codes, allowable diagnoses, treatment dates, SOAP notes… ARGH SO MUCH DATA!

Save yourself the headache of a disorganized practice. Use spreadsheets to track the diagnoses and procedure codes allowed by each insurance carrier, the amount they’ll pay for each procedure, and whether they’ve paid or denied your claims. This cuts down on claims guesswork, and will be an invaluable resource if any follow-up is needed.

5) Avoid These Insurance No-Nos

  • Billing too many office visits. Don’t bill for an office visit every time you see a patient, or overuse CPT codes like 99205 or 99215. These can get you red-flagged.
  • Treating your immediate family. We all love our families and want the best care for them, but billing for someone in your immediate family is another way to get red-flagged. We strongly advise against it.
  • Changing your address or Tax ID information without enough notice. Insurance companies can take MONTHS to update their records. Meanwhile, your checks are being mailed to the wrong address – or your claims are denied. Read your contracts before making ANY changes to your address, Tax ID number, or other important information. The sooner you notify the companies and your biller, the better shape you’ll be in.
  • Using the wrong ICD Codes. On October 1, 2015 America switched from ICD-9 to ICD-10 codes for all patients. When billing for a date of service before October 1st, use ICD-9 codes. If the date of service was on or after 10/01/15, use ICD-10 codes. Your claims will be rejected if you submit the wrong codes. It’s also very easy to make errors when typing these codes. Trust us, the difference between R15 and R51 is HUGE. Make sure you’re billing for the right diagnoses and procedures by double-checking your codes.