Reduce Denials: Fertility Billing Practices to Increase Claim Approval Success
The entire success of your fertility clinic depends on the efficiency of your revenue cycle management process.
Many factors make the process of fertility billing a personal hell for providers like you, like byzantine insurance rules and policies, excessive documentation requirements, constant coding changes, and the barrage of both state and federal government regulations.
It is no surprise that you do not always recover the reimbursements considering the errors within the billing and coding processes.
If you are tired of high claim denial rates, and staff burnout, and your revenue generation process is crippled, it is time to think about a new strategy.
Implementing industry best practices and cutting-edge technology in your fertility clinic can help you eliminate the challenges in fertility billing and improve your revenue in the long run.
This resource walks you through how to make the best of your fertility billing processes and procedures, whether you are setting up a new practice or looking to improve your current situation.
Beat Your Fertility Clinic Billing Issues
The humongous quantity of data and intricacies of the payers’ claim submission rules make billing problems inevitable in your clinic.
In fact, administrative mistakes like inconsistency in patient identification or coding errors lead to claim denials. This is a major concern for the providers because once the claim gets rejected it is highly unlikely to be paid.
As the industry experts estimate, 65% of the denied claims are never resolved and you lose a substantial amount of revenue due to the same.
There are two big fixes that can help you get out of this pitfall.
1) Patients’ insurance verification:
Gather as much data as possible and make sure they are comprehensive. Not only for a new patient, but you must also verify a patient’s health insurance coverage even if they are regular.
Nearly one-third of your patients change employment each year, which triggers a switch in insurance policies. Consider running weekly verification for those patients who are receiving services regularly, such as therapy.
2) Data automation:
Manually moving data between patient records and billing systems leaves room for errors and increases the chances of claim rejections and denials. Also, it is time-consuming and tedious which can make your time scarce for patient care.
Integrating your electronic health record system and billing software systems can make the data transition smoother and there are very few chances of mistakes within the billing process.
Identifying and Fixing the Most Common Coding Errors in Fertility Billing
Avoiding coding errors is tough, and when it comes to fertility services, obstetrics and gynecology procedures are also interwoven within the process. It is very evident that there will be confusion, and your fertility billing services will be more prone to errors.
Mistakes within the coding process will of course lead you to claim rejections, denials, and lost revenue. But this is not where it ends, it can also lead to charges of abuse and civil or criminal penalties when the payer is a government agency!
The common yet significant coding errors that can happen in your fertility billing process are-
Inaccuracy or missing modifiers
The inappropriateness of global codes
Unbundling
Upcoding and down coding
Failure to obtain prior authorization
Even a study shows that without addressing these errors providers have lost almost 7% of their revenue.
Wondering how to get rid of this?
Well, before there is an audit, consider periodic internal audits and review all your coding and documentation.
Create a list of requirements for prior authorization as well as coding. Always review the same before claim submission to ensure higher clean claim rates.
Clean Claim and Denial Management in Fertility Billing Services
A clean claim rate is the ratio of accurate claims to inaccurate claims submitted on the first pass. The industry benchmark says the clean claim rate should be at least 95%. A lower to this indicates systematic problems in your billing and coding processes.
To resolve this, track and monitor the claims submitted and analyze claim reports to understand the denial rates and patterns.
A lack of a denial management system often contributes to obscured revenue. The most efficient way to deal with claim denials is to run weekly or monthly claim denial reports.
You can gather missing information, correct data errors and appeal for resubmission within the payers’ timeline.
Unlock Your Revenue Potential with a Fertility Billing Company
The key to boosting your revenue can be an outsourced revenue cycle management organization. A company that specializes in fertility billing and coding processes can eliminate all the hurdles in revenue generation in your clinic.
Companies like this have a huge pool of professional and expert medical billers and coders, who can instill confidence in your practice with their industry comprehensive knowledge and expertise.
Expert billers consider claim scrubbing and tracking to ensure each claim is optimized for payments. Also, you can customize your fertility billing solutions as per your practice’s requirements. This makes outsourcing more cost-effective and efficient compared to an in-house team.
Look for a billing partner who can solve the problem of fertility billing services and promote your practice’s growth in the long run.