Common Roadblocks to Reimbursement and How to Avoid Them
At MSOC Health, we are claims filing aficionados, and as a result, we developed a vast cheat sheet of ways to avoid common billing and reimbursement roadblocks.
Here are the top five ways to smooth the collections process:
- Medicaid is always the payor of last resort – If a patient has multiple insurances, always list Medicaid LAST.
- Medicare and Medicare Advantage plans are mutually exclusive and cannot be filed for the same claim – If Medicare Advantage is active at the time of service, then traditional Medicare policy would be archived. Never file the other as the secondary for the patient.
- ACA Open Enrollment starts November 1, 2015, and many other employer sponsored plans start the benefit year over on January 1, 2016 – Check eligibility on everyone, ensure your PM system or clearinghouse can screen eligibility. Do this BEFORE the patient is seen or you may be working for free.
- Flu Season – Make sure you know the correct HCPCS code based on your supplier. View the codes here.
- North Carolina Medicaid providers – If annual visit limits on NC Tracks are blank that means the patient hasn’t had a visit yet. This a known issue and CSC is working on it.