3 Medicaid Billing Issues NEMT Companies May Face

July 31, 2020
Last updated on July 31, 2020
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Medicaid billing is the backbone of NEMT business cycle management. However, lots of providers and billers face significant challenges with billing. Billing operations must be performed accurately and efficiently so that providers get paid on time. But this process is a pain point since it involves an array of stakeholders and every step to get reimbursements relies on effective interaction. 

But not only that! One of the biggest Medicaid billing issues is filing claims correctly due to the state requirements. It’s a complicated procedure that entails special knowledge and skills because Medicaid programs vary from state to state, plus, claims consist of codes. That’s why lots of errors, both human and electronic, often happen.  

Here, you’ll find 3 most common Medicaid billing issues that NEMT providers often face. Besides, we’ll provide you with useful tips that will help to streamline and enhance the billing process.    

Rejected Claims

The most frequent New York Medicaid billing problems are rejected and denied claims. They are not the same as some new providers think. Let’s find out what the difference is between them.

Rejected claims contain 1 or more errors discovered before these claims are processed, that’s why insurance companies or other payers can’t pay the bills. Rejected claims are returned to providers with an explanation of the error to be corrected. After correction, claims can be submitted again.  

The main reasons for rejected claims are clerical errors, mismatched procedures, or ICD codes. However, the biggest problem is the patients’ eligibility issues. Front-end staff must ensure a patient’s demographic information, his/her health insurance status, and coverage to prevent rejections. As ClaimRemedi research has shown eligibility issues are the main reasons for rejections. Payers reject more than 7 percent of submitted claims due to these concerns. The research found that providers didn’t ask patients the right questions, causing multiple claim refusals.   

A good solution that can help to prevent rejections is “scrubbing” - a process employed by clearinghouses. However, it still takes some time before the rejected claim returns to the provider. 

The best decision here is using BillPro Medicaid billing software which guarantees creating and submitting only “clean” claims. This way, providers won’t waste time on additional correction, therefore, get reimbursement faster.    

Denied Claims

Denied claims are the ones processed by the payer but considered unpayable. When payers send denied claims back to the provider, they include the error explanation so that it can be corrected. On the other hand, claims can be appealed and transmitted to the payer again for processing. Unfortunately, this procedure is time- and labor-consuming, so providers and billers must do their best to create clean claims on the first go. 

What are the reasons for denied claims? Mainly, it happens when claims violate the contract terms (e.g., patients’ eligibility issues) or contain vital errors that were caught after processing. Such errors may include incorrect patient’s or provider’s information, incorrect insurance provider information, and incorrect or mismatched codes. Actually, coding inaccuracy is a significant challenge for many providers and leads to frequent denials. That’s why experts recommend regular training on ICD coding updates and interacting with healthcare providers if there are any documentation problems.  

Luckily, NEMT providers can avoid denials and payment delays if they use the right software like BillPro which ensures generating error-free documentation.    

Incorrectly Paid Claims

Sometimes healthcare providers and NEMT providers have to deal with such major billing issues as incorrectly paid claims. It means that providers are underpaid or don’t get reimbursements at all. It may become a significant problem because the investigation, correction, and reprocessing claims take weeks or even months and providers can’t get paid adequately. 

Why does such a situation happen? Primarily, incorrect billing codes cause payment issues.  

To prevent incorrectly paid claims, providers should minimize or even eliminate manual billing operations. Because of manual operations, a billing manager overworks having a stack of claims piling up on his/her desk. A number of human errors are unavoidable under such circumstances, hence, providers will experience problems with reimbursements. 

The best solution here is advanced technology such as BillPro software that “knows” necessary codes, state regulations, and other important information for generating accurate claims. Thanks to the software, providers are guaranteed to get fast and correct pays.      

Final Thoughts

NEMT companies are doing important but hard work and, obviously, they must be appropriately paid. For this reason, providers and billers should reduce all inaccuracies and complications of billing Medicaid claims. Since claim management is a complex procedure, we believe that NEMT providers don’t have to walk through this challenge alone! 

BillPro software bridges often a wide gap between providers and fast reimbursements. This platform automates all billing processes and makes managing the practice easier than ever. Thanks to the use of software, there will be fewer errors, therefore, claim rejections, denials, and incorrectly paid claims. 

To sum up, BillPro software is reasonably priced, easy-to-learn and utilize technology created for NEMT providers. It eliminates errors and ensures that providers are adequately reimbursed.  

This unique software saves time and hassle! Subscribe today and stay in full control of the billing operations and your business profitability!  

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About the author

Emmy Kolbe is a copywriter at NY BillPro, where she spends her days writing about Medicaid billing software solutions and NEMT industry. She creates content for both emerging and existing transportation companies. She has a bachelor’s degree in journalism and mass communication from St. Bonaventure University. 

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