Learn best practices for getting insurance claims paid promptly
Editor's note: For more coverage of the 2020 AAP Virtual National Conference & Exhibition, visit https://www.aappublications.org/news/2020/08/21/nationalconference2020.
For many pediatricians, coding and billing are not at the top of their priority list. But they should be, according to Susan J. Kressly, M.D., FAAP, chair of the AAP Payer Advocacy Advisory Committee and member of the Section on Administration and Practice Management.
“There are a lot of pediatricians who say, ‘But I take care of kids,’” Dr. Kressly said. To which she replies: “If there is no margin, there is no mission.”
Whether you own a solo practice or work for a large integrated health system, you need to have a business sustainability model, she said. “So it’s everyone’s responsibility to pay attention to the money because that allows us to care for the children.”
One area to target are the costs associated with reprocessing insurance claims. Dr. Kressly offers guidance during a session titled “Rejected! Advice on Avoiding Claim Denials.” The session can be accessed via the virtual platform through Jan. 31, 2021.
Claim denials are a growing problem for a number of reasons, Dr. Kressly said.
The COVID-19 pandemic has pushed many practices to rely heavily on telehealth visits. While coverage for telehealth visits has been expanded, coding and payment are complex, with “payers being all over the place,” Dr. Kressly said.
Other reasons claims are rejected are they list two diagnoses that are mutually exclusive or they include a Current Procedural Terminology code that has been retired.
In addition, many families have lost their jobs due to the economic downturn and may have lost their health insurance as well. If practices don’t verify coverage at each visit, they run the risk of submitting claims to a company that no longer covers the patient.
“Having the accurate information about what the patient’s coverage is at the date of service is probably the biggest thing that any practice can do,” Dr. Kressly said.
During the session, Dr. Kressly discusses other best practices for getting “clean claims” out the door the first time, reducing the chances that they are rejected.
“We are all being financially stretched and stressed by both changing payment models in pediatrics but more so by the COVID pandemic, and so cash flow is a problem everywhere,” Dr. Kressly said. “Anything you can do to more efficiently, effectively have claims go out the door and paid promptly, the better off for your organization and even your job security.”
Dr. Kressly also presents “Crossroads in Crisis: Your Practice During COVID-19” (L2501) with Suzanne K. Berman, M.D., FAAP, and “How to Optimize Screening and Get Paid for It.” Access the sessions via the virtual platform through Jan. 31, 2021.
