7 Common Speech Therapy Billing Mistakes that Lead to Claim Denials and Rejections

Feb 10, 2020 9:00:00 AM

Getting insurance claims accepted quickly can be challenging for speech therapy clinic owners. Medical billing is complex, and therapists aren’t spending their time researching the intricacies of billing — they shouldn’t be expected to. But for a clinic to operate sustainably, it must mitigate claim denials and rejections. You need cash flow to be consistent, and you can’t rely on timely reimbursements without getting your claims accepted the first time you submit them.

Streamlined reimbursements depend on your ability to provide insurers with the information required in the format necessary. In this post, we examine the seven most common speech therapy billing mistakes and how you can avoid them.

Mistake 1: Not Using the Most Accurate ICD-10 Codes

Coding is probably the most troublesome aspect of claims submission for speech therapy clinic owners. There are dozens of codes that may apply to your diagnoses and services, and the rules that govern them are precise. It can be difficult to remember which codes apply in which situations. 

ICD-10 codes, the codes that describe your diagnoses, can be especially challenging since they’re so specific. In any given case, one code may work, but another code may better describe your diagnosis and allow for reimbursement for the services you need to provide. You’ll want to be familiar with the ICD-10 codes you’ll use most often, and keep handy a list of all speech therapy ICD-10 codes along with their descriptions. Be sure to review this list before assigning a code to each case. 

Mistake 2: Not Using the Most Accurate CPT Codes

It can also be difficult to know which CPT codes are most accurate for the services you’re providing and which will deliver the maximum appropriate reimbursement. CPT codes precisely describe services or combinations of services. As with ICD-10 codes, you may find that more than one CPT code works — but only one will most accurately describe the services you are delivering. Alongside your list of ICD-10 codes, keep a list of speech therapy CPT codes and refer to your list before identifying a CPT code for your claim. 

Mistake 3: Forgetting Applicable Modifiers or Using Them Incorrectly

Code modifiers allow you to get more specific about the services you provide. For example, you may have an atypical case that requires additional time spent with the patient, or you may perform two separate procedures on the same day but not at the same time. Sometimes, forgetting applicable modifiers will result in a rejection because the insurer wants more information. A rejection or denial can also happen as a result of using a modifier incorrectly. Here, the solution is also to become familiar with the modifiers you may need and the rules governing them.

Mistake 4: Inaccurate Use of Time-based Codes

While most CPT codes that speech therapists use are untimed (session-based), you may occasionally need to use a timed code — for example, code 96125 (standardized cognitive performance testing, per hour of a qualified health care professional’s time, both face-to-face time administering tests to the patient and time interpreting these test results and preparing the report). 

When using timed codes, it’s important to know the rules surrounding them — for example, the 51% rule states that you must spend at least 6 minutes with a patient to use a 15-minute code, 16 minutes for a 30-minute code, and 31 minutes for a 60-minute code. Medicare has additional (different) rules governing timed codes. If you use timed codes improperly, you’re likely to receive a rejection or denial.

Mistake 5: Failure to File on Time

Every insurer has its own guidelines for when a claim must be filed. Some are as short as 30 days. You need to know when your deadlines are and have procedures in place to make sure that claims get filed when they need to. The best way to ensure timely filing is to use a checklist of steps that your personnel use each every time they go through a process.

Mistake 6: Missing Information

Attention to detail is essential when it comes to getting claims accepted. Anything from a missing certification to missing date of onset can cause a claim to be rejected or denied. Again, following a checklist will help ensure that each piece of necessary information is included on your forms.

Mistake 7: Human Error 

Humans are, well, human. When you’re using a manual claims submission process, you will encounter a certain amount of human error, despite your best efforts. For this reason, automation is invaluable. The more of the claims submission process you can automate, the better. Take advantage of software with scrubbing functionality such as Fusion Web Clinic’s billing software that will auto-create claims and identify potential problems.

Avoiding these common mistakes will boost your claims acceptance rate and help ensure you aren’t wasting time resubmitting rejected claims. As you work toward improving your claims acceptance rate, you’re simultaneously improving the sustainability of your clinic, allowing you to continue serving patients for the long term.  

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