Dresden Medical Management Group

Insurance Verification Mistakes: Is Your Medical Practice Losing Revenue Before the Patient Is Seen? Week 2 | Where Medical Practice Revenue Problems Really Begin Let's talk about something that happens before a patient ever sees the provider. Insurance verification. It sounds simple enough, doesn't it? Check the insurance, confirm coverage, and move on. But anyone who has worked in a busy medical practice knows it's rarely that simple. Policies change. Coverage terminates. Benefits vary. Authorizations may be required. And sometimes, the information provided by the patient doesn't match what the insurance company has on file. One missed detail can create a revenue problem before the appointment even begins. The Cost of Getting It Wrong Imagine your practice provides a service, submits the claim, and expects payment. Then the claim comes back denied because coverage wasn't active, the wrong insurance was billed, or a required authorization was missing. Now someone h...

Let's talk about your front desk for a moment. It's one of the busiest places in your practice. Phones are ringing. Patients are checking in and out. Appointments need scheduling. Insurance cards need updating. Someone has a billing question, and another patient needs help with paperwork. And somewhere in the middle of all that, your staff is expected to capture accurate information that directly affects whether your practice gets paid. That's a lot of responsibility for one team. Small Mistakes. Expensive Consequences. A misspelled name. An incorrect policy number. Coverage that wasn't verified. An outdated insurance card. They seem like small details. But when inaccurate information makes its way into a claim, the consequences can be much bigger. Rejected claims. Denied claims. Delayed payments. Additional follow-up. And here's what we sometimes overlook: Every preventable billing error creates more work for a team that's already struggling to keep up. The fro...

Part 5 of Our 5 Common Medical Billing Mistakes That Are Costing You Series Let's talk about something that happens in medical practices every day. A denied claim.  Someone makes a note to follow up. But the phones are ringing, patients need attention, payments need posting, and another stack of claims is waiting. So that denial gets pushed to tomorrow. Then next week. And before anyone realizes it, that claim has been sitting for months. Sound familiar? A Denied Claim Doesn't Always Mean Lost Revenue Many denied claims can be corrected, appealed, or resolved with additional information. But someone has to work them. And when denials sit too long, appeal deadlines can pass, turning potentially recoverable revenue into money your practice may never collect. The frustrating part? Your practice may have already earned that money. It's simply waiting for someone to follow up . Is It Really a Staff Problem? When denials start piling up, it's easy to assume someone isn't ...

So far in our 5 Common Medical Billing Mistakes That Are Costing You series, we've talked about incorrect patient information, coding errors, and missed timely filing deadlines. Most of those mistakes have an obvious consequence: Your practice doesn't get paid or payment gets delayed. But some billing mistakes can create a different kind of problem. They can put your practice at risk. One example is unbundling services . What Is Unbundling? Unbundling occurs when services that should be billed together under one appropriate code are instead billed separately. Sometimes it can happen because of a misunderstanding of coding requirements. Other times, someone may be working from outdated information or simply miss how certain services should be reported together. Regardless of how it happens, incorrect coding can lead to claim problems and potentially raise compliance concerns. And that's why this isn't something practices should treat as just another billing error. When ...

  The patient was seen. The service was provided. The documentation was completed. Your practice earned the revenue. But what happens when the claim isn't submitted—or corrected—in time? You may never get paid. Because sometimes the problem isn't whether a claim should be paid. It's whether your team got to it before the clock ran out. A Good Claim Can Still Become Lost Revenue Insurance companies establish deadlines for submitting claims and those requirements can vary by payer and contract. But filing the original claim isn't the only thing that requires attention. A rejected claim may need to be corrected. Missing information may need to be located. An insurance issue may need to be researched. A claim may need additional documentation before it can move forward. Every delay eats away at the time available to resolve the problem. And when a claim sits too long, what began as a correctable billing issue can eventually become revenue your practice may no longer be abl...

Last week, we talked about how something as small as incorrect patient information can create a much bigger revenue problem. But what happens when all the patient information is correct, the claim is submitted and it still doesn't get paid? Sometimes, the problem is hiding in the codes. Medical Billing Codes Don't Stand Still CPT and ICD-10 codes change. Codes are added, revised, and deleted. Guidelines change. Payer requirements can vary. And documentation still has to support what's being billed. Keeping up isn't something you do once and check off the list. It requires ongoing attention. And in a busy medical practice, that responsibility may be sitting with someone who already has a very full plate. That's where problems can begin. An outdated code, incorrect code selection, or mismatch between the documentation and what was billed can result in a rejected or denied claim. Then the work starts all over again. Someone has to identify the problem, review the claim...