Missed Charges ? Impact

Posted by Deepak Sanghi on March 5th, 2016

As the US healthcare reimbursement landscape becomes more challenging, there is absolutely no room for any oversight, let alone errors!  With all the changes including ICD-10 medical Coding, Payer guidelines especially regarding timely filing, credentialing and contracting etc., it is imperative that the Provider/Facility gets every service paid – on time, every time.  One of the areas with potential risks for lesser payments is missed charge entry in medical billing.  With US Billing companies getting paid a percentage of what they collect, this has direct impact on their revenues.  Let us analyze below some of the common reasons why Charges could get missed or overlooked.

Documentation:  The foundation for successful and accurate medical claims processing is the documentation from the Provider/Facility.  The Billing Company or its staff are not present during the Provider-Patient encounter, and fully depend on the documentation to create the claims.  If the Provider/Facility fails to mark a service or miss it due to oversight, then the corresponding medical billing charge entry will not be done.  Sometimes Providers also fail to document a service thinking that it goes along with another service they have done (bundling), but in reality there could be possibilities of getting both services paid.

Errors in medical billing charge entry:  Another area where errors are prone to happen is during the actual process of charge entry in medical billing.  The person entering the Charges could get distracted half-way through entering the multiple charges for a claim and might miss a few.  There could also be misinterpretation of guidelines provided by the Provider/Facility on some Charges that need not be entered.  Medical billing charge entry is the most important step in the process, as it involves assigning a $ value to the services rendered by the Provider/Facility.

There could be errors that are missed during the claims transmission process, especially if the claim goes out on multiple HCFA/UB forms, like those for Labs.

Clarification oversights:  The medical claims processing function always has ambiguities.  These ambiguities are raised as Clarifications to the Provider/Facility, while the claims are kept on ‘Hold’ from transmission.  The same process also happens when an offshore medical billing entity works for a US Billing company.  If these clarifications are not handled on a consistent and timely manner, then there are chances that the claims might get transmitted with missed or wrong Charges, or not transmitted at all!

Impacts of missed Charges:  The impacts of missed Charges are all too apparent! It leads to loss in revenue for all parties involved, except for the Payer!!!  Apart from the revenue loss, the other impact is when the Provider/Facility reports their PQRS data.  Since the service does not get documented at all as Charges, the scores that the Payer will assign to the Provider/Facility will be below than what they actually deserve.

Offshore medical billing can lessen this impact by having specialized teams doing the medical billing charge entry, along with additional Audit levels to ensure none of the Charges are missed.

About e-care India:

e-care India is one of the pioneering offshore medical billing companies based in India that promises to avoid the risks involved with missed Charges. With 16 years of experience in the industry, e-care’s 3 delivery centers have been providing end-to-end medical claims processing services seamlessly to its clients. To know more about e-care and its services, log on to www.ecareindia.com