Audiology billing is hardly simple and straightforward. This complex process can become even more so depending on the patient, insurer, and service.
Even the most diligent professionals will experience claim denials or holdups, but knowing some common billing blunders can make it far less likely.
Why Billing Matters
First, let’s establish the basics of billing and why they’re important.
Billing is the process of gathering data from a patient’s intake and appointment paperwork, creating a clean claim, and submitting that data in a unified way for insurance reimbursement.
Error-free billing ensures timely cash flow and revenue, which makes it much easier to cover expenses. It also contributes to an overall positive patient experience by reducing patient stress, fostering trust, and enhancing overall satisfaction.
Most Common Billing Blunders
Intake and verification
Gathering incomplete or invalid information will delay payment and may result in zero pays. Examples of errors include:
- Patient can’t be identified based on the information in the claim paperwork
- Medicare Advantage issues denial because they’re not the primary insurer
- Verification of benefits isn’t completed on the hearing aid claim
Billing and coding
Lack of proper and timely credentialing, poor documentation, and missing data can delay payment or result in claim denial. Examples of errors include:
- New provider is not yet credentialed with the payer
- Modifier is missing on a monaural hearing aid claim
- Modifier AB is missing on a Medicare claim
- A BCBS FEP claim doesn’t have prior authorization
- UHC doesn’t have required supporting documentation
Claims submission process
Outdated processes can lead to payment delays or timely filing write-offs. Examples of errors include:
- Not clear whether an invoice is ready to be billed to insurance
- Paper claim sent with no copy on file for checking status
- A clearinghouse rejection isn’t addressed by clinic staff
- No plan B if something happens to your clearinghouse
A/R and denial management
Lack of consistent A/R monitoring will slow or stop cash flow. Examples of errors include:
- Not clear whether an invoice is ready to be billed to insurance
- No process for addressing denials, which hinders timely filing
- For private-pay A/R, not sending statements consistently
- No process for review of the aging report
Solutions
Ensure a standard of work for all processes — consistency and excellence in every step is crucial to practice success.
Intake and verification
Patient ID
Always scan insurance cards so that you have accurate patient identification. This will avoid further delay if your claim is rejected by a clearinghouse.
Medicare Advantage
Educate staff thoroughly on the nuances of Medicare Advantage plans and primary vs. secondary insurers so billing is accurate and patients aren’t frustrated.
Verification of Benefits
Perform a thorough verification of benefits for all insurance-covered hearing aids before dispensing to ensure clarity and prevent billing issues.
Billing and coding
Credentialing
Implement a credentialing process and keep credentialing up to date. When a new provider starts, make a spreadsheet to track where you are on the credentialing with each payer.
Documentation
Document each service performed, and train your staff on how critical it is that documentation is clean and correct. For example, the date on the purchase agreement needs to match the dispense date.
Claim requirements
There are a lot of moving parts to a claim, and it’s easy to get tripped up. Get a process in place to make sure payer documentation and claim data requirements are met every time. Important pieces to have in place include:
- Start new-provider credentialing ASAP after hire
- Keep staff trained and up to date on frequently used modifiers
- Get prior authorizations squared away before services are performed or materials are dispensed
- Keep patient files updated with any required documentation
Claims submission process
Consistency and efficiency across the board can only happen with well-documented processes. Establish clear and comprehensive documentation for the following, then consistently adhere to them — you’ll get better results and maintain a healthy A/R.
- Start new-provider credentialing ASAP after hire
- Keep staff trained and up to date on frequently used modifiers
- Get prior authorizations squared away before services are performed or materials are dispensed
- Keep patient files updated with any required documentation
A/R and denial management
Consistent A/R and denial follow up is essential to managing Accounts Receivable. Ensure you’re running the right reports and managing your private payers.
Reporting
Each month, run your review your A/R summary by payer and a detailed payer report. Check the overall health of each payer and whether the buckets are growing as the invoice is aging out. Run and review payment and adjustment reports every month as well.
Private payers
Have a solid process in place for sending a statement every 28–30 days. If more than three statements are sent, the patient should be called. If no response, mail a final notice and either write the debt off or turn it over to a collection agency.
Final Thoughts
Remember, the path to billing proficiency is paved with diligence, continuous learning, and a commitment to excellence. The field of audiology billing is always evolving, so staying proactive and informed is key to success.