3 Billing Issues You Can Solve Without New Software or Staff

If you’re responsible for operations, revenue cycle, or patient access, you already know that:

• Margins are shrinking
• Teams are overloaded
• Revenue gaps persist

Every week, clinics and healthcare systems face billing issues costing hundreds of thousands of dollars. The solutions don’t require new software or extra staff—they simply require execution.

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1. Denials Tied to Intake & Scheduling Errors

Issue Overview
Billing denials often begin at intake, even though the reports tend to blame coding or authorization errors.

What We See

• Outdated or incorrect insurance plans selected in the EHR
• Appointment types that don’t match the scheduled provider or coverage rules
• Front-desk staff skipping eligibility checks for returning patients

Consequences

• Payers rejecting claims as ineligible
• Visits scheduled under plans that don’t support the service
• Multiple billing edits in 277 reports or denial queues

Fixes

• Lock eligibility checks behind appointment confirmations
• Configure your EHR to flag mismatches between appointment type and payer
• Assign a single team member to review top eligibility-related denial codes monthly

Impact: Teams that implement these processes see a 20–35% reduction in eligibility-related denials.

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2. Hybrid and Telehealth Visits Misclassified or Underdocumented

Issue Overview
Virtual and hybrid care visits are frequently misclassified or underdocumented because outdated billing pathways haven’t kept up with clinical operations.

What We See

• Full video consultations documented incorrectly as “phone visits”
• Missing place of service or time-based details
• Providers unsure how to document consent, modality, or time
• Incorrect or omitted modifiers (e.g., no -95, -GT)

Fixes

• Configure default visit types to require place of service (POS), CPT, and modifier selection
• Include a three-point checklist for each virtual note:
  • Consent received
  • Modality (audio/video)
  • Time spent
• Train schedulers to distinguish between codes such as 99214, G2012, and T1015

Impact: Properly coded telehealth claims can improve reimbursement by $20–$90 per visit, depending on the payer.

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3. Recurring Denials That Never Get Solved

Issue Overview
Some denial categories appear every month because no one has time to investigate them thoroughly.

What We See

• Repeated denials for line items like 96372 or 36415 due to bundling or missing documentation
• Claims rejected because of referring provider NPI mismatches
• Missing modifier -25 on E&M plus procedure codes
• No feedback loop when clinical documentation doesn’t match the billed level

Fixes

• Pull denial codes occurring more than five times a month
• Assign each denial code to a single accountable person
• Create a simple, three-column tracking sheet:
  • Denial Code
  • Root Cause
  • Resolved (Y/N)

Impact: One FQHC system uncovered $80K in preventable write-offs without adding staff or new technology.

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Bottom Line

• Objective: Aim for small but crucial improvements to protect your margins and reduce burnout on billing teams.
• Solution: These aren’t just optimizations—they’re essential steps to prevent leaks without needing more software or hires.
• Next Step: If you want help identifying one revenue loss you can fix this quarter,
  Book a 20-minute Ops & Revenue Review with BettyWell.