How to prevent incorrect claim payments

October 26, 2021
Last updated on October 26, 2021
3 min read
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If you’re a medical biller, you know that claim errors are a common part of the process—but that doesn’t make them any less frustrating. Claim errors often lead to rejections or denials, but they can also cause incorrect payments. Sometimes these situations are unavoidable, but one of the best ways to combat errors altogether is by using software for Medicaid billing. If you switch to an automated process and you know what to do if you’re faced with an incorrect payment, claim errors won’t seem so daunting. 

What is an incorrect claim payment?

If a Medicaid claim was paid incorrectly, it means providers were either overpaid, underpaid, or not paid at all. In any case, it’s an issue that needs to be resolved. Depending on the severity of the problem, it could take some time to get the right amount of money back in your pocket. If you think you’ve received an incorrect payment, the first thing you should do is contact the insurance company and explain the payment issue. Keep a record of everyone you talk to in case follow up calls are necessary. 

How to prevent incorrect payments 

Incorrect payments can be tricky to handle, but if you know how to decrease the likelihood of them, you’ll be in better shape to tackle them head on if they land in your inbox. We’re lucky enough to live in a time when technology is at the forefront of nearly everything we do. If you’re operating with cloud-based Medicaid billing software, you’re already in a good position for success. The following are some additional ways to prevent incorrect payments at your practice:

Verify patient benefits ahead of time 

Before an appointment, providers should verify a patient’s insurance policy to make sure their plan covers the service they’re seeking. This is one of the easiest ways to prevent billing issues and typically only takes minutes to confirm. Whether the patient is brand-new or returning, front-end staff should take the time to check insurance plans before the service is billed incorrectly. 

Verify personal patient information in advance

In addition to insurance information, office staff needs to confirm that patient information is correct before an appointment. This includes the patient’s name, sex, birthday, address, etc. It’s crucial that all of this information is written down correctly; otherwise, it could easily result in a claim error. 

Double check data and codes 

If you’re billing with NY Medicaid billing software, the system will catch any incorrect or missing ICD codes and appointment information before a claim is submitted. If you’re still billing manually, you run the risk of submitting claims with critical errors, which may or may not be fixable in the long term. 

Avoid upcoding

Upcoding is the process of billing for a procedure that yields a higher reimbursement cost than the one the patient actually received. This is a highly illegal practice that could cause your company to undergo an audit. Additionally, if your billers are found to have upcoded intentionally, they could face harsher penalties. Upcoding more likely happens by mistake, so it’s worth putting your team through regular trainings to limit the possibility of this happening. 

Schedule your free BillPro demo

We offer everyone a free look at our software in action. If you want to see how our NYS Medicaid billing software can take your business to new heights, sign up for your demo today. 

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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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