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:
1. 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.
2. Improper Treatment Documentation
Another big reason claims go into aging is improper documentation. If a patient’s illness is not properly documented, payers can cry foul. This is particularly problematic in behavioral health, as it can be hard to “prove” emotional issues if they are not well documented.
For this reason, it’s important that all medical and clinical staff are up to date on ASAM criteria for assessing patient need. This way, both payer and provider can speak the same language, and get on the same page when it comes medical necessity and patient care.
3. Improper Treatment Delivery
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.
For more information on our services, visit www.panaceahcs.com or call 866-731-6777