Claim denials are one of the most common causes of inconsistent revenue streams throughout the medical and mental healthcare industries. Not only does it cause delays with incoming revenue, but many require a response to questions, or appeals, which further rob your thriving practice of valuable time that could be better spent treating patients.
Of course, this also means that one of the top goals for any competent autism billing company, all healthcare providers, and administrative billing staff is to find ways to reduce or completely eliminate them. Though, it’s also worth noting that accurate credentialing is a very crucial component of achieving this goal.
Anytime a provider, or small practice accepts a healthcare professional, they need to vet them extensively to ensure the highest level of quality and competency for their patients. At the same time, providing insurance companies with inaccurate information can frequently lead to denials. Especially when you consider that even the smallest missing piece of information can lead to a major delay in the claim fulfillment process.
This might have you wonder how can I avoid credentialing-related denials to maximize my small practice’s income for a more consistent revenue stream?
The answer lies in a few important practices that need to be applied when bringing any new practitioner on board.
Make Sure To Always Be Time Conscious
The two most common credentialing errors tend to occur when you hire a new provider, physician, or practitioner as well as when contacting an insurance company to ensure payment validation.
Vetting All New Practitioners & Providers
One of the most common missteps in new hiring is rushing through the credentialing process. After your organization has established standards, all of those standards need to be reinforced consistently. Though doing so requires time and due diligence.
Any new physician or practitioner’s education history and resume need to be reviewed and thoroughly vetted. This needs to include contacting references, as well as reviewing all records to ensure accurate filing.
If you miss any of these crucial steps when you hire on a new provider or partner with a new practitioner, it can lead to a bevy of denials later on down the road. Even if your small practice later decides to separate from this individual after hiring, it can still cause red flags through various payer and public health institutions.
Avoiding Credentialing Denials
When it comes to insurance credentialing denials, most of them can be circumvented by simply avoiding the communication delays that can sometimes occur between a provider and an insurer or public health institution. If you happen to have a larger practice, then you might want to consider taking responsibility for your company’s own credentialing.
This can help eliminate costly time exchanging files and requesting information. Though taking this route might open the door for your payers the ability to audit your company. If possible, consider having a third-party audit performed by an outside firm. This will go a long way toward avoiding a lot of the red flags that insurance companies look for in the credentialing component of medical billing and claims reviews.
Make Sure To Update Important Documents
A lot of medical certifications require revalidation at one point or another. The majority of insurance payers and public health institutions have rigid standards when it comes to the types of certification information that are acceptable. This includes time restrictions on when certain documents become invalid.
A lot of these institutions treat revalidation as being legally required, and different organizations have unique requirements. For example, your physician’s paperwork may be correct for Medicare, but Anthem required a new document a week ago.
The best way to avoid any confusion and remain timely in all your responses is to keep a clear list of what companies need updates and when. You can then distinguish between types of institutions, such as state-run or private. Many federally run health programs have similar standards.
Review & Address All Potential Delays
Timeliness is a critical component in many facets of the medical billing industry. Especially when it comes to credentialing, coding, and reimbursement rates. Any time an insurance payer or public health institution finds a credentialing mistake, they will typically take longer to review the potential error.
Not only can this impact the consistency of your revenue stream, but it can also mar your practice’s reputation in the medical billing industry. Any time an insurance company finds a detail that needs review, then it’s likely that other companies will do the same. Failing to identify and correct this detail can significantly increase the waiting period before payment verification.
If a public health institution or insurance company takes longer than expected to review a claim, it’s wise to be proactive and contact them. Be sure to let them know that you are eager to fix the issue and want to know what is causing the holdup. Even if the cause of the delay is technically no problem, the fact that it wasted so much time suggests a change is necessary.
Be Prepared For Potential Delays
Being able to predict how long a provider will take to be approved by a payer or public health institution can be tricky. However, failing to accurately predict what that acceptable window of time is, can be a critical error. It also happens to be one that many practices commit.
A lot of insurance payers frequently have high workloads, and your practice may be a low priority. So, be sure to give your practice at least 90 days from the requested date to the expected time of approval. If it goes beyond that, you might want to proactively reach out to the payer institution in question to see if any questions need to be resolved.
It helps to make sure you have experienced personnel to lead your billing team. These people are much more likely to give an accurate, experience-driven assessment of work and wait time.
Be Proactive About Consistent Problems
If your practice has been experiencing multiple denials, immediate action is necessary. Often, t is helpful to create a report detailing common errors. Record what the underlying problems are and narrow down consistent patterns. After identifying any problematic patterns, be proactive about eliminating the errors that created the denials.
Knowing When to Hire Professional Help
If your practice has one or more insurance payers or a public health institution that is constantly denying your practice’s verification requests, you may be in more trouble than you can handle without outside help. Many practices in this scenario will hire a billing and collections service to verify all the credentials of the providers on staff. This will go a long way for a small practice that is hoping to speed up the collection process or for larger companies hoping to avoid costly audits.