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Urology Claims: The Do’s & Don’t’s of Filing Urology Claims

As a urology professional, you know the ins and outs of your practice. Here are a few helpful tips to ensure that your claims billing process maintains an even keel.


Do Verify Patient Information

As with any claim submitted to insurance, verification of patient information is critical. Be sure to obtain the patient’s insurance information, verification of date of birth and Social Security number, as well as home address, and SOAP notes from the physician after the exam. Correct information for the patient will allow for urology claims to be approved within the patient’s coverage.

Do Verify Provider Information

It’s also important to verify your own information! When filing a urology claim, be sure to provide your practice’s correct address and contact information, as well as identification numbers and EDI processing numbers.

Do Scrub Claim With a Clearinghouse

Using a clearinghouse to verify the claim helps to increase efficiency and avoid errors within the claims process. An efficient clearinghouse will check your urology claims in order to ensure that each claim is error free before final submission. If an error is found, the clearinghouse notifies the billing professional. Fixing errors before final submission minimizes weeks of headache down the road for incorrectly filed or coded claims.

Don’t Resubmit Denied Claims

If a claim has been denied, it probably has been denied for a good reason. Before you automatically resubmit the denied claim, verify that the claim is error free. If the claim contains errors such as incorrect diagnosis codes, then it is possible that this is the reason for denial. Verify with the attending urologist which diagnosis codes should be assigned to the patient within the claim before proceeding with resubmission.

Don’t Double Bill for Visits

Some visits are not able to be submitted for claims twice under specific insurance coverage provisions. Specifically, Medicare has very clear regulations about billing for postoperative visits. Click here to read more about those regulations.

Don’t Forget the Clearinghouse

We really can’t say this enough. The purpose of a clearinghouse is to ensure that each urology claim is error free. A properly designed clearinghouse identifies errors, and notifies the claims professional of errors to be corrected before final submission.

Without the clearinghouse, it is possible and likely that claims will be submitted with errors. Error filled claims are likely to be denied based upon the errors within, causing your practice to resubmit the correct claims a second time. This submission and resubmission takes additional time and resources, causing a deficit in both time and money for your urology practice.

Follow these simple steps when filing a urology claim, and you’ll be sure to receive payment from payers in no time. For more information on clearinghouses for urology practice, visit this page.

Articles with this disclaimer may not represent the beliefs or core values of Apex EDI. The following is simply a summary taken from the industry’s general community to help readers stay up-to-date on what people are talking about. 

Posted in: Urology Claims

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