How To Avoid Rejected Claims

How To Avoid Rejected Claims

Alongside patient care and running your health practice as efficiently and effectively as possible comes the financial management side of things, more specifically, ABA billing.

It may seem daunting and complex to tackle the billing process, but there are some simple yet effective strategies that you can put in place to ensure that not only is the billing process approachable, but it will ensure that you avoid rejected claims as much as possible.

To learn more about these tips and how to implement them, keep reading below. 

Understand The ABA Process

Of course, one of the first things to ensure is that administrative staff and those concerned with the finance department are fully aware of and understand ABA processes.

Being familiar with the terminology of ABA billing and the steps needed to bill for services correctly is one of the best ways to pre-emptively avoid mistakes because it’s better to catch them sooner rather than later.

Understanding Billing Codes

As part of the ABA billing process, one of the ways in which the procedure can be made more efficient is to ensure that you are wholly familiar with the billing codes.

Not only is identifying the codes important, but it is equally important to ensure that you are using the correct codes and doing so accurately for individual cases at hand so that you are able to bill for the correct amount and avoid any rejected claims.

Pre-Authorized Verification

Even before the bill can be generated, one of the ways that can greatly reduce the chances of anything going wrong in the finance department is if you pre-emptively check and verify the insurance coverage of a patient.

Doing so can ensure that you avoid billing for anything that isn’t covered in their insurance, and it can rule out any services that don’t apply to them. Not only is this a lot more efficient, but it will also save a lot of time in the long run as you will have already confirmed even before any services have been carried out if their insurance plan is able to cover a particular service or not.

Organized Documentation

Another way that can smooth out the process is just with a bit of additional organization, and this is making sure that you have all the updated and required documentation needed to support any ABA billing claims. 

From the get-go, ensure that you keep the patient’s agreed treatment plans. This includes any initial assessments, progress notes, and even post-service assessments, along with any other relevant documents to be able to submit. 

Insufficient documentation is a more common reason for claims being rejected than you’d think, so keeping accurate and updated records for each patient will make sure that this isn’t the case for you.

Up-to-date Billing Codes

Another aspect of ABA billing that you make sure that you are keeping up with is making sure that when the billing codes are updated annually, you are also familiarizing yourself with them and making sure that the correct codes are being used moving forward.

Providing adequate training for the staff responsible for putting in claims is extremely important if you want to avoid any rejected claims, and annual training will assure you that the updated codes are being followed and submitted. 

Timely Submissions

Another reason for rejected claims is due to submitting delayed claims, which result in delayed payment and sometimes outright rejection.

Similar to the documentation that was mentioned above, an efficient and streamlined organization will mean that claims can be submitted sooner rather than later. This way, you can have peace of mind that there are no outstanding claims still waiting to be submitted from months ago.

Thorough Final Review Before Submission

As much as pre-emptive checking and organization will help you in the long run and will cut down a lot of time, the final check is just as important as you may catch something that wasn’t seen before.

Time should be dedicated to thoroughly reviewing the claim before it is submitted to make sure it is accurate and complete without any minor errors, such as spelling or grammar mistakes, or even major errors, such as missing information or incorrect services being billed for.

Double-checking at the end will really make a world of difference, and we’d even recommend it being a different member of staff than the one who filed the claim so that there is a fresh perspective and the chances of catching any errors before submission will be much greater.

Organization Is Key

In conclusion, it is clear that one of the key things that will ensure that you can avoid delayed or rejected claims is being efficient and organized as much as possible.

From pre-emptively verifying a patient’s insurance to keeping accurate records, updated billing codes, and thorough final reviews — the thing they all have in common if they are to work properly is being organized, and the success of your ABA billing system heavily relies on it. With so many incoming patients on a daily basis, it might be easy to overlook things, but with a proper system in place and with all staff working together, you can create a streamlined system that delivers strong results.