Dresden Medical Management Group

  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 An outdated code, incorrect code selection, or mismatch between the documentation and what was billed can result in a rejected or denied claim.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...

Some time ago, I shared a blog about 5 Common Medical Billing Mistakes That Are Costing You . It became one of our most-read posts and that tells me something. Practice owners know billing mistakes are expensive but they want to understand where they're happening and why they keep happening. So, over the next few weeks, we're going to take a closer look at each of those five mistakes, starting with one that seems incredibly simple: Incorrect or incomplete patient information. It may sound like a small administrative error. But small errors at the beginning of the revenue cycle can create much bigger problems at the end. It Starts With One Small Detail A misspelled name. An incorrect date of birth. An old insurance card. A changed policy number. A new employer. A patient whose coverage terminated last month. Any one of these can create problems when the claim reaches the insurance company. And suddenly, your team is spending additional time correcting information, resubmitting c...

  Today, I want to share a real case study that perfectly illustrates why looking at an aging report is only the beginning. A client and owner of a medical practice believed there was approximately $23,000 in outstanding insurance A/R. That was the number they understood to be sitting in the revenue cycle. But after reviewing the accounts and digging into the underlying activity, I found something very different. Approximately $134,000 in outstanding insurance balances. That meant there was roughly $111,000 more sitting in the revenue cycle than ownership realized. At first glance, that sounds like great news. But this is where the story gets important. Finding a balance does not automatically make it collectible revenue. So the real question wasn't: "How much A/R is there?" It was: "What does that $134,000 actually represent?" And once we broke it down, the answer became much clearer. What Was Actually Behind the $134,000? Approximately $27,800 had already been...

Over the past two weeks, we've been talking about something many medical practices experience but don't always recognize right away. It starts with an overwhelmed team. Everyone is working hard, but important tasks are still falling behind. Then comes the realization: Maybe this isn't a productivity problem. Maybe it's a capacity problem. Last week, we took that one step further and asked: Does everything we're currently doing in-house really need to stay in-house? Which brings us to the natural next question: When does outsourcing actually make sense? Outsourcing Doesn't Mean Replacing a Good Team Let's start here, because this may be one of the biggest misconceptions about outsourcing. The goal doesn't have to be replacing employees. Sometimes it's exactly the opposite. Outside support can be a way to protect the team you already have. If talented employees are spending their days chasing aging claims, researching denials, managing credentialing de...