Common Roadblocks to Reimbursement and How to Avoid Them

 In Articles, Coding & Documentation, Provider Notes

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:

  1. Medicaid is always the payor of last resort – If a patient has multiple insurances, always list Medicaid LAST.
  1. 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.
  1. 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.
  1. Flu Season – Make sure you know the correct HCPCS code based on your supplier. View the codes here.
  1. 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.
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