How do you think top revenue cycle management companies manage vision billing rejections without hassle?  Is it not a difficult task to perform? If you are noticing more vision billing rejections, it means your claim rejection percentage is increasing day by day! Do you think there are solutions? Let’s see how vision billing rejections occur in the first place and solutions to stop them.

Attempts to reduce account receivable are an ultimate lifeline for vision billing practices. For a constant growth in business, it’s necessary to follow continuous and seamless revenue flow. It might be a greater risk if your claims are rejected often.

However medical billing rejections are different as denials and rejections are often used interchangeably and also don’t meet specific formats, billing methods and requirement of data. A rejected claim will never be processed by insurance companies as well as the centers for Medicare and Medicaid Services.

Satisfying news is that there’s a chance for resubmitting the claim after fixing the errors. But it’s important to resubmit the claim within the time period provided by the insurance companies. Top revenue cycle management companies will look through the possibilities of claim getting rejected and find certain solutions to avoid them occurring in future.

Let’s see the six vision billing rejections faced by healthcare professionals and also revenue cycle management companies in common:

Rejection 1: Invalid or Information had gone missing:

  • Data entry is considered to be one of the most crucial steps in medical billing as incorrect or invalid information can push healthcare professionals into a huge loss.
  • So, always confirm the demographic details obtained from the patient during data entry process for the claim.
  • A missing field or misspelled name and ID number will be the main cause to trigger a rejection call against healthcare professionals.
  • Rejections are common even if one digit number goes missing in patient ID number. Complete attention towards entering the details such as patient name, ID number, age, address and date of birth are to- be-filled requirements.
  • A recent survey states that almost 33% of claim rejections are due to inaccurate information provided in demographic details. It costs more than $6 billion annually for U.S healthcare industry.

Check new Medicare ID cards:

  • CMS has already begun distributing new Medicare ID cards for Medicare patients, depending on geography location mailing strategy.
  • Medicare has made an attempt of removing Social Security number from ID cards and adding MBI- Medicare Beneficiary Identifier with 11 alphanumeric characters.
  • So, healthcare professionals must claim their Medicare bills using the following MBI.
  • This could be a challenging task as any missing characters will take them to rejections.
  • Top revenue cycle management companies and healthcare professionals must indulge in the new process of replacing the numbers with MBI characters in Insurance ID field.
  • Verify patient’s information in the new Medicare cards and re-correct the inaccurate fields and incase if the address is different, inform the patients to update them immediately.

Rejection 2: Duplicate Claims:

  • Rejections due to duplicate claims are something that healthcare professionals had submitted them twice on the same day. Medicare or Private insurance companies will not pay for the duplicate claims.
  • Only the first approved claim will be paid and the duplicates will be rejected according to the regulations.
  • Top revenue cycle management companies often check the claims twice before submitting them as these duplicate claims will be usually rejected and reimbursements will be at risk.

Rejection 3: Invalid codes and Missing Modifiers:

  • If you have submitted your claims with incorrect or invalid codes and modifiers are missing in the claim or just a blank without anything filled, then you have to wait for your rejections instead of reimbursements.
  • Insurance companies are very keen in rejecting the submitted claims those are with invalid codes and no modifiers attached for the date of service billed.
  • Better continue to start with LCD to ensure accurate coding claims and also follow the procedures for resubmitting the claim by correcting the codes once again.

Rejection 4: Eligibility Verification:

  • For vision billing eligibility verification stands as a crucial process for claim submission.
  • Verify if the insurance data is accurate with the plan and policy details along with term dates.
  • Pre-authorization for specific plans and services are required and obtain them without fail.
  • It’s essential to verify patients out of pockets, co-pays, co-insurance as well as the deductions.
  • Top revenue cycle management companies are experts at eligibility verification before the claim is sent to clearing house or insurance companies.

Rejection 5: Invalid or Missing Healthcare Provider ID:

  • Ensure accurate Provider’s ID, National Provider Identified (NPI) and Taxpayer identification number (TIN) during claim submission.
  • If the insurance companies do not hold accurate provider’s ID number to validate their identity, the claim will be rejected by them.
  • Top revenue cycle management companies will ensure to provide accurate provider details necessary for claim submission and prevent future disturbances.

Rejection 6: No proper Credentialing:

  • It’s important to ensure proper credentialing from healthcare professionals end and verify if they are credentialed by insurance companies prior to claim submission.
  • Some insurance companies will need healthcare professionals to credential with their specific plans available.
  • RCM companies simplify the credentialing process with document review to participate in specific plan.
  • They also aid in tracking and submitting provider’s credentialing applications that depends and based on insurance plans.

Hope you got the information on vision billing rejections. For more suggestions, please comment below, we will definitely consider them if relevant. For more queries and updates on healthcare, please subscribe to our blog.