NEMT (Non-Emergency Medical Transportation) billing is a complex process that requires adequate management. Some companies outsource this entire department to save time cost and increase productivity. Others prefer doing it inside, which is also known as in-house NEMT Billing.
When managing independently companies encounter various problems including denials and delays. This article will explain how you can avoid such issues and achieve maximum productivity.
What are Delays and Denials in NEMT Billing
Denials and delays are problems related to claim processing and reimbursements for transportation services given to individuals requiring NEMT. Over time, the rate of denials and delays is increasing rapidly. According to the Medical Group Management Association, the denials and delays percentage has increased by 17%.
In addition, the expense of working on appeal denials is $25 for the practices and $181 for the healthcare facilities like hospitals. However, the good news is you can successfully recover the rejected claims and save a couple of dollars.
Recovering the rejected claims is not rocket science. It requires a calculated approach towards finding the problem and coming up with the solution.
In order to avoid financial damage from denied claims, a great strategy is to prevent it from happening. In simple words, you have to understand the reasons that contribute to kickback claims
- Authorizations: Your claim will be denied when service is given without obtaining authorization
- False Information: Incorrect information such as incorrect social security number, Plan code, or a missing modifier.
- Coverage of Medical Services: When a service is not covered by the policy and there is a disagreement between the payer with the physician.
- Duplicate Claims: When the service provider submits a claim on the same day of providing the particular service.
- Grouping the services: when the paying individual combines two different services and pays a specific amount for both.
- Exceeded Data submission time: you may experience this problem when the individual files his claim after the provided time limit.
Apart from the above-mentioned problems, you must dig deeper to find the real reason behind denials. There are 4 denial codes
- Other adjustments (OA)
- Contractual obligations (CO)
- Payer-initiated reductions (PI)
- Patient responsibility
For instance, the CO 24 code is used when a patient avails medical services out of his current benefit plan.
How to Resolve NEMT Delays and Denials?
Delays and denials only reduce your working efficiency and waste money. An obvious way to resolve these issues is to file error-free claims, and process information of the right persons. Doing this will ensure smooth and effective NEMT Billing.
Here are five ways to resolve NEMT delays and denials, explained in simple English:
Plan and Schedule Early
When you are aware of an upcoming medical appointment, it’s a great idea to plan and schedule your NEMT (Non-Emergency Medical Transportation) service in advance. This proactive approach allows you to ensure there’s ample time to organize transportation that matches your specific needs.
Timely planning and scheduling increase the likelihood of securing the right transportation and reduce the risk of last-minute rushes or complications.
Double-Check Eligibility and Documentation
Double-check your eligibility and documentation when it comes to NEMT (Non-Emergency Medical Transportation). You should reach out to your healthcare provider or insurance company to confirm your eligibility for NEMT.
This verification ensures that you have all the required documentation in order, which is crucial for preventing denials and ensuring that you can access the transportation you need for your medical appointments.
Communicate your needs clearly When arranging your NEMT (Non-Emergency Medical Transportation. You should articulate any specific requirements, like wheelchair accessibility or medical equipment. This open communication allows the transportation provider to prepare adequately for your needs.
By doing this, you minimize the chances of delays and ensure that your transportation is equipped to accommodate your unique requirements, making your journey smoother and more efficient.
Follow Up and Confirm:
Confirming your NEMT (Non-Emergency Medical Transportation) appointment before the scheduled date is vital. This verification step prevents last-minute problems like cancellations or delays.
In addition to that, confirmation gives you peace of mind, reducing stress, and allowing time to make alternative arrangements if needed. This crucial action enhances the reliability of your medical transportation, making your appointment more manageable and less worrisome.
Appeal Denials if Necessary
If your NEMT (Non-Emergency Medical Transportation) request is turned down, it’s important not to lose hope. You have the right to appeal the decision. Get in touch with your insurance or healthcare provider to learn why they denied your request. Then, work with them to present your case.
This appeals process allows you to advocate for your transportation needs, understand the reasons behind the denial, and potentially have it overturned, ensuring that you can access the necessary transportation for your medical appointments. Don’t be discouraged – the appeal process can provide a second chance to get the assistance you require.
Effectively NEMT billing management is crucial for healthcare providers and patients. By understanding the common reasons behind these issues and taking proactive steps, you can streamline the process and ensure that individuals needing non-emergency medical transportation receive the care they require without unnecessary complications.
Frequently Asked Questions
How to Avoid NEMT Delays and Denials
To reduce delays and rejections you have to
- Make sure the front desk team codes and bills correctly.
- Keep patient info and records accurate and complete.
- Send in claims quickly.
- Stay in the know about any changes in the insurance claim process.
What are 3 Mistakes in a Claim Resulting in Denials?
The top three errors that often lead to claim denials are:
- Insufficient claim details.
- Missing information on the claim.
- Late submission of the claim (also known as Timely Filing).
What is a Dirty Claim in NEMT Billing?
A dirty claim in NEMT billing is a claim with mistakes like missing details, leading to rejection by insurance, and requiring corrections for payment.
What are the reimbursement NEMT Billing Methods?
NEMT billing methods involve
- per-trip payments,
based on trips or miles driven for patient transportation.