Trailer billing not being reimbursed?
Trailer billing is a term used to describe the process of billing for services that are reported after the initial claim has been processed. This often occurs with procedures or services that have delayed reporting, such as certain laboratory tests. In these cases, a healthcare provider may treat a patient but delay submitting the claim due to administrative backlog. However, during this time, the patient's insurance policy may change to cover less of the procedure's cost. When the provider eventually submits the claim, they may receive less reimbursement than they would have under the original policy. Another factor that can lead to underpayments is the complexity of healthcare charging practices. For example, underpayments can occur when the costs of care approach the limit set by the insurer, known as the stop loss. If a provider unknowingly exceeds the stop loss limit and charges are refused by the payer, it can result in an underpayment scenario. This can be particularly problematic when a patient requires urgent additional treatment that pushes their expenses over the stop loss cap before the reconciliation process takes place. The discrepancy is typically resolved after the treatment has been administered, potentially leaving the healthcare provider under-compensated temporarily.
How do I track all these new medical billing codes?
Medical billing codes are subject to frequent updates, with the American Medical Association (AMA) introducing 225 new codes, removing 75, and revising 93 this year alone. Consequently, certain codes, such as home care plan oversight codes 99339 and 99340, were eliminated in 2023. Payers may reject payment for services associated with these codes. In pharmacy billing, calculations involving dosages, days, and packaging often require the use of multipliers. Mistakes when applying these multipliers can lead to charging errors and subsequent underpayments. A simple miscalculation, such as misplacing a decimal point when billing for medication, can significantly decrease the prescribed and billed amount.
Revenue Capture Errors
Revenue capture is the process of accurately documenting and billing for all services provided. Failing to capture all of the services can result in underpayments. For example, forgetting to bill for an additional procedure performed during a patient's visit can result in an invoice that is less than what should be charged. Major surgeries are typically billed based on time, while less invasive procedures are often charged separately. It's common for one or two procedures to be missed when there are multiple chargeable procedures. Coding is an essential part of the healthcare revenue cycle, but errors or oversights in this area can lead to underpayments. There are various coding-related issues that contribute to underpayments.