Tips to Avoid Claim Denials

The world of behavioral health billing can be a confusing one. There are a lot of moving parts that go into submitting claims, getting authorizations, sending the right paperwork, etc. The hope is that by doing all of this your claims will pay in a timely manner, so your business can continue operating. However, we all know that sometimes you think you’ve done everything correctly and claims still get denied.

In this post, we’re talking about the top five things to consider in an effort to make sure your claims don’t get denied.

Understand the relationship between Utilization Review (UR) and Billing

In the billing process, getting treatment services authorized in a timely fashion by the UR team is extremely important. After authorization is obtained, it is equally important to bill correctly according to the authorization and the insurance providers’ preferences. Claims can be rejected because the billed codes don’t match what the insurance provider put on the authorization or because certain insurance providers don’t consider certain codes acceptable for a level of care (we’ll discuss this later in the article). We’ve also encountered insurance providers incorrectly inputting authorizations into their system, for example, filing it under the wrong tax ID or marking authorizations as denied when they were not

Document, Document, Document

Sufficient medical record documentation is key for successful behavioral health billing. Inadequate documentation can trigger all sorts of issues with insurance providers including medical necessity denials, allegations that services were not rendered as authorized or billed, as well as audits. All of which can lead to delays and denials for claims billed. Documentation training is also key so all clinicians and staff are fully aware of how to document properly.

Be Familiar With Individual Insurance Providers

While many insurance providers expect a lot of the same things when it comes to processing claims, there are differences and subtleties between providers. Different policies may require different documentation so it’s important to be aware of that. In addition, certain providers will only pay for certain types of facilities. Lastly, certain insurance providers are more likely to deny services for medical necessity. Because of this, it is so important to have knowledge and experience with the insurance landscape and the specific needs of each insurance provider.

Keep An Eye On the Client’s Policies

A simple mistake that can be made leading to a claim denial is if a patient’s policy ends or lapses during their stay at a facility. It’s key to ensure that all clients’ policies remain active throughout the duration of their treatment and that coordination of benefits is completed when needed.

Ensure All Paperwork Is Signed Up Front

Getting clients to sign paperwork is one of those things that can easily be breezed past, thinking you’ll just get to it later. However, the issue is that it can get missed entirely and facilities are unable to contact clients after they discharge. When the paperwork isn’t signed, reimbursement for entire stays can be lost. We advise getting all client paperwork signed upon admission — including documents assigning rights to the facility for payment.

At CA Billing, we pride ourselves on extreme attention to detail so none of these key elements for proper claim processing slip through the cracks. As a business, we know how important it is that claims get paid, so you get paid — so we do everything in our power to make sure that happens. Learn more about how we can help you with behavioral health billing and avoid claim denials by contacting our office and requesting your free consultation.