With the increasing demand for fertility services, the industry is going through numerous changes every now and then. From changing coding regulations to variations in payers’ claim submission guidelines, providers like you struggle to keep up with the changing fertility billing requirements. 

You need to accomplish several steps accurately to obtain reimbursements. However, with increasing patient volume and workload, you are making mistakes in fertility billing and coding, which are resulting in claim denials and revenue loss.  

In this blog, we have discussed some of the common yet significant mistakes that can cause you substantial revenue loss.   

1. Not staying updated with industry standards: The healthcare landscape is constantly evolving both in terms of clinical and administrative protocols. Therefore, it is essential for you to understand the latest industry guidelines and standards considering coding and billing procedures. Lack of compliance with regulations and standard procedures results in errors and claim denials.    
   
   
2. Missing information: The absence of accurate information on file cannot justify your rendered services thus causing claim denials and revenue loss.    
   
   
3. Lack of prior authorization: Failing to obtain prior authorization is a prevalent issue in fertility billing. As the claim submission guidelines vary from state to state in this specialty, it is difficult to keep up with prior authorization requirements as well. The variability in authorization demands often leads to mistakes in the billing process which eventually lead to claim denials and a slow revenue cycle.  
   
   
4. Lack of insurance verification: Verifying insurance benefits and patients’ eligibility is essential to understand the coverage specifications. If you lack understanding about the same, you can end up rendering services that are not covered by the patient’s insurer. In this situation, either the patient must pay out of pocket, or you might have to write that account as bad debt. This takes a toll on your revenue hindering your clinic’s financial and functional stability.   
   
   
5. Missing claim filing deadlines: Each insurance payer has a different claim submission timeline. Not adhering to the deadlines of claim submission can result in claim denials and substantial revenue loss.   

In the fertility billing sphere, mistakes are common. But you can prevent them with time and industry best practices at hand.   

• Capture accurate patient data: Whenever a patient visits your clinic, it is crucial to collect accurate and comprehensive patient data. A wrong or missing information in your billing leads to inaccurate coding and documentation resulting in claim denials and revenue loss.
  
  
• Ensure insurance verification: Always verify your patient’s benefits and insurance coverage to understand the possibilities of reimbursements. You should always stay up to date on the most recent modifications and regulations because insurance coverage differs from business to company and plans are subject to frequent adjustments. To prevent future disputes with your patients, you should also inform them in advance of any prospective out-of-pocket costs. 

The following methods can be used to confirm insurance:  

• A patient's insurance provider can be contacted directly by phone or email.
• For flawless email verification, you can also visit their web portal.   

To minimize manual effort, and human error, and optimize reimbursements, you can put in place an ideal, efficient workflow.   

Create simple invoices: Always make sure that your bills are predictable, understandable, and contain all the required information.   

Adherence to compliance: Sustaining regulatory compliance in your fertility clinic billing solutions can help you mitigate the risks of audits, penalties, and fines. Stay up to date with the current claim submission guidelines and coding regulations to avoid mistakes in your fertility billing services.   

While implementing the best practices in your fertility clinic billing demands substantial resources and time, outsourced RCM companies are a more feasible solution for managing your operations.    

A reliable RCM organization can streamline your fertility clinic billing solutions with their expert medical billers and coders. These professionals are well-versed in industry-comprehensive practices and technologies that help you eliminate errors and enhance your billing process.    

In this evolving healthcare landscape and competitive market choose an RCM organization that can eliminate errors and instill confidence in your fertility billing solutions.