Tips for Tackling Home Infusion Denials for Improved A/R

Written by: Brenda Langlais on Monday, July 18, 2016 Posted in: Home Infusion

error blog-01Reimbursement is every providers’ lifeblood.  But too often, particularly with complex home infusion billing, a few small mistakes can result in denials. The good news is mistakes are avoidable, and you can reduce your losses by following a few tips.

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Mistakes to avoid:

While denials may result from incorrect coding, it is actually quite common for claims to deny for either of these two non-coding reasons:

1. No prior authorization. If you provide medications, supplies, or services before payer approval, the payer will deny the claim. Proper intake and communication of the patient’s service needs and understanding of the payer’s authorization requirements will alleviate many of these denials.  When in doubt call the insurance company, you cannot afford to take chances, most payers will not retro a ‘prior’ authorization.

2. Failure to verify eligibility. Before providing infusion services, you must verify eligibility and benefits of the patient ensuring the patient’s coverage for the specific area of care.  Patients may be unaware their insurance plan does not cover infusion services.  Perhaps they have a separate drug plan, a copay, or an outstanding deductible.  Always verify coverage to determine if you can afford to service the patient, who is paying for what?  Does the reimbursement cover your direct and indirect costs?  It is your job to make sure every supply, drug, equipment, and service is being paid by the payer, if not you need to have a conversation with the patient.

 Handling denied claims:

When claims are denied, it’s important that you:

  • Find similarities. Group them according to billing codes, types of service, payers, etc. Now you can ask yourself: Who are the problem payers and what are the common denials? By identifying problem trends, you can avoid making the same mistakes in the future.
  • Prioritize. Decide which claims need to be addressed first according to dollar amount or time-sensitivity. Providers often have 45 days or less to appeal denied claims. Start early so that you do not lose your ability to respond.
  • Work on them every day. Correcting denied claims is an ongoing process. Work on them as soon as possible, so you can avoid repeating the same mistakes.
  • Familiarize yourself with payer contracts. Again, the only one looking out for your best interest is you, so know the guidelines including what is covered, and what is not.

In the home infusion industry, as with all healthcare, being paid is crucial to your survival, every claim dollar counts.  Step back to see the bigger picture so you can pinpoint the problems, make a plan of action, and ensure that you are collecting every dollar for which you are entitled. See how Mediware Reimbursement Services can improve your A/R with proven results to lower DSO and increase collections.

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