Rehab billing is difficult to say the least. There are several pitfalls that you need to watch out for in order to “get paid right the first time”. Here are the top 7 most common mistakes you may be making: 

1. Inaccurate Benefit Checks

Incorrect benefit checks can lead to denials, unnecessary write-offs, and even negative patient reviews due to unexpected out-of-pocket expenses.  You need to know the right questions to ask when obtaining patient benefits to get the most accurate information.   For example, what are the patient’s financial responsibilities (co-pays, deductible, etc.), does the plan require a referral/authorization, what is the plan year, the list goes on...  Training your staff on the right questions to ask when checking patient benefits can eliminate potential problems. 

Tracking authorizations and referrals is the only way to ensure that you won’t receive denials for “no authorization” or “no referral”. Once denied, some of these claims may never be paid. Practices that don’t run tracking reports and follow-up are almost guaranteed to lose money.  

3. Insufficient Knowledge of Insurance Guidelines   

It can be difficult to remember all of the insurance specific guidelines that can affect whether or not a claim gets paid. For example, Rhode Island worker’s comp does not recognize common CPT codes such as 97110, they only pay 5 codes (X7001-X7005). 

If you are not familiar with all applicable guidelines, bills go out, get denied, need to be rebilled and reprocessed. Delayed payments can be avoided by training your staff to investigate these trends or outsourcing to companies that are familiar with your state’s billing processes.   

Rehab practices that bill daily have a faster turnaround time for insurance reimbursement and resubmission of denied claims. Practices that bill weekly, bi-weekly, or even worse, monthly are more likely to write-off claims due to timely-filing limits and have a harder time with establishing a consistent cash-flow.

5. Improper Use of Modifiers 

Most insurance companies now require modifiers.  Common modifiers in rehab billing are 59, KX, GP, GO, and GN. The proper use of these modifiers can be a deciding factor in whether or not a claim gets paid.  Fun fact: claims typically will not be denied for having too many modifiers but they will certainly not get paid if modifiers are missing.  

6. Not Working Denials Daily 

In our experience, over 90% of denied claims have the potential to be corrected and paid if quickly resubmitted. However, denials that aren’t immediately worked and resent when received are at risk of never being paid due to timely filing limits. This problem can be easily be solved with proper denial management processes being implemented.  

Improper credentialing can not only deny payment, it can be a compliance nightmare. For example, unless a new therapist is in the credentialing process, billing for treatment done by that therapist under another therapist's number is non-compliant.  YOU HAVE TO credential every practitioner that works for your practice – even part-timers. 

Additionally, if your staff isn’t tracking re-validation dates or updating insurance companies with demographic changes, your contract could be terminated and all claims will be denied.  

If you are sabotaging your billing it’s not too late to fix it.  Training your staff, having the proper processes in place and tracking results is the first step to getting your billing function back on track and getting “paid right the first time”.