Many ODs may notice their claims aren’t being reimbursed, and in many cases they don’t have the bandwidth to investigate or they don't know where to start in order to figure out what went wrong. For someone who doesn’t handle the billing process on a daily basis, fixing denials can be a daunting task.
However, if you have defined your processes, it’s just a matter of reviewing each of them to find out where it has broken down. For practices who don’t have a system in place for managing claims, an in-house biller might be the most obvious solution.
We want to examine the processes at a typical office and review the biggest mistakes that could be made at the following stages:
- The OD Performs the Service
- The Front Staff Invoices the Patient for the Services
- A Biller Files the Claim
- The Clearinghouse Scrubs the Claim
- The Payer Accepts or Rejects the Claim
- The Payer Produces an EOB/ERA
- The Payment is Posted into Your PM System