The Pile up! Top Reasons for Aged Claims in behavioral healthcare billing
Providers lose millions in unpaid claims. Here’s why your claims are aging, and what you can do to improve reimbursement rates.
Claim aging is one of the biggest issues in healthcare today – especially in behavioral health, where there is so much subjectivity when it comes to medical necessity. This is why it’s important for providers to understand why their claims go into aging – and what they can do about it.Here are the top three reasons for claim aging:
Billing / Coding Errors
Payers are constantly updating their standards and guidelines. And, any coding that falls outside of compliance can quickly fall into aging. As such, it’s imperative for billers to keep on top of new coding standards for each of the payers they work with. If you are using an in-house billing department, they may be too overwhelmed to stay up on the latest payer guidelines (And it’s not necessarily their fault
(Payers are not always up front about these changes.)
Fortunately, if you have claims in aging due to billing and coding errors, you can perform a forensic audit – going line by line, and claim by claim, to determine where the errors are, and how to fix them.
Improper Treatment Documentation
Many payers pre-approve treatment but do not guarantee payment unless certain standards are met. For this reason it’s crucial that your staff be familiar with payer standards and guidelines when it comes to the timeliness of treatment delivery. (You may, for example, get pre-approved, but only reimbursed if the appropriate assessments were completed in the payer-mandated time frames.)
This is no easy task – as all payers have different standards and protocols.
One Big Solution for Claims in Aging: An Interdisciplinary Approach
It can be extremely difficult for a small team to keep abreast of payer standards and guidelines, while dealing with a full patient load. This is why we use an interdisciplinary approach to billing – employing collectors, forensic billers and clinical consultants to communicate with payers, find billing errors, and train our client’s staff on best practices.
This way, you can avoid having future claims in aging, while collecting payment on unpaid claims.
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