When dealing with claims that span multiple dates, such as inpatient stays that cross month or year boundaries, there's no room for error. Payers scrutinize these claims more than others, looking for any excuse to deny or delay payment. Understanding how to properly bill services across date ranges can mean the difference between a full payout and a months-long appeal battle.
Defining a Spanning Claim
A spanning claim covers services provided over a continuous period that extends through different billing periods. Think of an inpatient admission that starts in one month and discharges in another. These are the claims that often clog the appeals pipeline, primarily due to errors in date entry or misunderstanding payer rules.
Why Spanning Claims Are Challenging
Spanning claims trip up even seasoned billers. Payers can have different rules on how they want dates reported. And it's not just the big details like admission and discharge dates — even small inaccuracies can lead to denials. Dates must align with medical records and physician orders to the letter — any discrepancy can lead to a claim rejection.
Common Errors
Incorrect Dates: You'd be amazed at how often the wrong admission or discharge date is used. Check your source documents.
Overlapping Services: Sometimes services from two different stays are billed together. Payers aren't fond of this.
Procedure Codes: If procedures span dates, each date must be accounted for accurately.
Key Strategies for Spanning Claims
Know Your Payer's Rules
Every payer has its own idiosyncrasies. Medicare might want one thing, while Blue Cross has a different playbook. Spend time with your payer representatives to learn their specific requirements for spanning claims. A quick chat can prevent hours of denial follow-up.
Accurate Documentation
Medical records should tell a clear, consistent story that matches up with your claim. Every date must align with physician notes, nursing records, and procedural histories. Inconsistencies invite questions — questions lead to delays.
Use Correct Codes
For inpatient stays, the use of correct codes is paramount. ICD-10 codes must reflect every procedure and diagnosis across the stay. And remember, procedure codes must accurately reflect the date they occurred. Failure to do so will trigger a denial faster than you can say "revenue cycle."
Verify Everything
A spanning claim requires multiple layers of verification. Check patient demographics, verify eligibility (particularly if coverage changes mid-stay), confirm admission and discharge dates, and ensure all services are bundled appropriately. Overlooking any of these details can be a costly mistake.
Billing Across Year Boundaries
Crossing over from one year into the next? This adds a layer of complexity. Some payers treat year-crossing claims differently, often requiring separate submissions for each calendar year. This can involve prorating charges or designating specific codes for services rendered in each year. Missteps here can lead to a tangle of rejected claims and lost revenue.
Handle Deductibles and Out-of-Pocket Maximums
When a claim spans a year, be acutely aware of deductible resets and out-of-pocket maximums. Patients’ financial responsibilities reset at the start of a new calendar year, which can influence both claim processing and patient collections. Make sure this isn’t overlooked — it’s a classic reason for patient disputes.
Software and Technology
Your billing software should support spanning claims. It should allow for date range entries and handle year-crossing scenarios. If your current system forces workarounds, it's time for an upgrade. Technology should reduce your workload, not add complexity.
Navigating Common Obstacles
Billing spanning claims isn't just about knowing the rules — it's about anticipating the hurdles. Payer portals might be clunky, or their customer service lines jammed with hour-long hold times. Keep detailed notes on previous interactions and don’t hesitate to escalate when necessary. Persistence pays off.
Train Your Team
Every member involved in the billing process should be versed in the nuances of spanning claims. Regular training sessions can keep everyone on the same page. This isn’t just about reducing errors — it’s about fostering a proactive approach to billing that sees revenue cycle management as a team sport.
Final Thought
Spanning claims demand attention to detail and a comprehensive understanding of payer-specific guidelines. They can be tricky, but they're not impossible. With the right strategies and a bit of vigilance, these claims can be managed effectively, ensuring that full reimbursement isn’t a lofty dream but a consistent reality.
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