Accepting insurance benefits you and your patients. Your patients gain access to services they might not seek out otherwise; you gain an invaluable opportunity to build a thriving practice. Once your credentialing is in place, accepting insurance improves your referral business without any marketing effort on your part; it is a passive marketing strategy. Passive marketing methods can be ideal for small businesses with limited resources.
But accepting insurance creates work for your office. Many providers are unprepared for the administrative workload that comes with running a clinic. Even if you’re not billing insurance, managing a clinic is complicated.
Let’s make it easier. Here’s a short list of insurance billing tips to guide you toward success. Enjoy!
Do your own research: patients may not always understand insurance very well. Register for Availity, OneHealthPort, and other web portals to access policy information online. Check your patient’s insurance ID card for web resources and contact information for the carrier’s Provider Services department.
Read Everything 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. Accepting insurance is a serious decision. Make sure you know what you’re getting into.
Contracts
Signing a contract obligates you to certain duties and terms. Read contracts carefully; pay special attention to fee schedules and contractual terms. Contracts outline mandatory discounts and carrier requirements for address changes and other demographic updates. If you don’t understand something, call your Provider Relations representative. (If you’re an Acubiller client, ask our team!)
Mail, Email, and Faxes
Insurance billing involves a lot of mail. Insurance companies regularly send correspondence via both email and physical mail.
In the past, our clients found it difficult to interpret the carrier documents they received in the mail. We routinely called insurance companies for clarification. Thankfully, insurance companies are increasingly using plain language in correspondence. Reading your mail carefully can prevent loss of time on phone calls.
Verify Patient Coverage Online or By Phone
Insurance doesn’t cover everything. The services covered by an insurance policy are called benefits.
Benefit verification is the process of researching patient eligibility, coverage information, and filing requirements. Insurance companies can provide a general overview of a patient’s coverage. However, they cannot guarantee coverage.
Coverage is contingent upon various factors, including but not limited to
- diagnoses (Cigna and Aetna are restrictive)
- satisfaction of referral and authorization requirements
- number of units (4 or less)
Your patient may be financially responsible for non-covered services. Before their deductible is satisfied, they are also responsible for all eligible expenses that accrue towards the deductible.
Whether or not the carrier pays, you are entitled to payment for your services. Manage your patients’ expectations accordingly.
Don’t Future Bill
Billing for services not yet rendered is insurance fraud.
Never bill before treatment occurs. We can’t stress this enough.
Get Organized
Running a clinic involves data management. Patient information, check numbers, payment deposit dates, patient lists, accounts receivable, invoicing, business overhead costs, carrier fee schedules, claim submission dates, CPT codes, allowable diagnoses, treatment dates, SOAP notes, copay and coinsurance amounts for each patient, authorization numbers and date ranges — without a plan, you can quickly become overwhelmed.
Spare yourself the headache of a disorganized practice. Use spreadsheets and EHR software to track your clinic data, and keep up on data entry. Consistency will help you take the guesswork out of insurance billing.
Avoid These Insurance No-Nos
- Billing too many office visits. This is an audit risk. Don’t bill for an office visit every time you see a patient. Be sparing with high-complexity procedures like 99205 or 99215. It may be inadvisable to bill office visits codes at all for some carriers.
- Treating your immediate family. Billing for relatives is ethically questionable and a huge audit risk. Don’t do it.
- Changing your address or Tax ID information without enough notice. Insurance companies can take months to update their records; meanwhile, they’ll mail your checks to the wrong address, or deny your claims. Moving without notifying the carrier in advance can wreck your cash flow. Read your contracts before making changes to your address, Tax ID number, or other important information. The sooner you notify the companies (and your biller), the better. See our guide to demographic updates.
- Using the wrong ICD Codes. Transposing digits in diagnosis codes is a common quality control fail. Trust us, the difference between R15 and R51 is HUGE. It’s very easy to make errors when typing out alphanumeric strings. Always double-check your work before submitting claims.