Tightening the Reigns on Medical Billing Claims

It has recently come to the attention of the Cahaba GBA Regional Home Health Intermediary that it is necessary to tighten the reigns on medical billing claims. Therefore, a study has been underway to try to find out exactly why certain claims have been denied. Through the course of this study, there have been a good number of findings to show that there have been denials of various diagnosis codes within the medical billing process.

Further studies by the Cahaba GBA have revealed that a large amount of the denied claims had actually shared the same diagnosis codes. Included in the list of diagnosis codes that are often denied are: 295. (Schizophrenic Disorders), 331.0 (Alzheimer’s Disease), 332. (Parkinson’s Disease), 496. (Chronic Airway Obstruction), 728.2 (Muscle Wasting and Disuse Atrophy, NEC), and 728.9 (Unspecified Disorder of Muscle, Ligament, and Fascia). There were actually multiple errors in these medical billing diagnosis claims in question, leading to a wide range of errors from approximately 35% up to 73%.

The main goal of this investigation of medical billing claims was in no way intended to create fear amongst certain medical practices. Instead, this process was started to simply try to make things run smoother with regards to medical billing in the years to come. After all, you will only learn from mistakes, and the same mentality comes into play when you are looking at certain claim denials. To make this process run even smoother, the Home Health Care Intermediary Cahaba GBA is actually going to keep their investigation of these claim denials open. This is being done with the hopes that the denials will not only lessen, but they will also be able to show when and where the errors are being made by those in charge of billing.

Many have been looking to nip the problem of errors in the bud by outsourcing the work to certain individuals who are well-trained in the field of medical billing. In the long run, this idea of outsourcing could actually save you a great deal of hassles. After all, it would only make sense that if you have more professionals working with the necessary skills to work with your medical billing, you are going to be able to cut out a large amount of errors. This is a trend that you should not ignore, because the faster you take charge of your medical billing practices, the less errors you will have overall.

View all Articles by: Melissa Clark, CCS-P