Errors in medical billing often stem from basic mistakes like eligibility verification or data entry. These errors cause significant payment delays and weaken healthcare facilities. To avoid such issues, practitioners, and billing auditors must proactively prevent errors and maintain effective team communication.
When handling medical bills, it is crucial to eliminate processing or coding mistakes in claim submissions. As healthcare providers heavily rely on successful claims for income, any errors can have a substantial impact on both you and your organization.
Common Medical Billing Mistakes
In this guide, we will outline various measures you can take to avoid typical medical billing errors committed by billers, ultimately reducing the incidence of claim rejections and denials.
Wrong Identity
A frequent error is the use of an incorrect patient ID number. When the front office staff receives incorrect information or if you mistakenly enter it into the billing software, the responsibility falls on the medical biller to rectify and resubmit rejected claims caused by the wrong ID number. Devoting time to verifying patient eligibility and ensuring the accuracy of insurance ID numbers can prevent future complications and alleviate unnecessary difficulties.
Transposing Digits
Similar to entering an incorrect ID number, it is effortless to transpose digits. Simply swapping two numbers without much thought can result in claim rejection, denial, and significant delays in insurance processing and payments. Transposing digits commonly occur when entering a patient’s date of birth, so it is crucial to thoroughly review all numerical data before submitting claims.
Sending claims to the irrelevant insurance companies
Sending a claim to the incorrect insurance company is a significant but easily avoidable medical billing error. This often happens when you lack a copy of the insurance card or fail to pay attention when entering the patient’s insurance mailing address or payor ID. To prevent this mistake, ensure both sides have a copy of the insurance card and enable front office staff to verify the practice management system and select the correct insurance provider.
Not putting the relevant code
In simple terms, code linkage establishes the medical necessity by connecting the diagnostic and procedure codes. It means that the patients’ treatment should align with their condition, ensuring that the procedures conducted by their Primary care physicians are medically justified and eligible for reimbursement. The claim will not be billed if the code linkage doesn’t indicate necessity. Enhancing your knowledge about procedures and diagnostic codes will help you evaluate the code linkage on your claims, preventing costly and time-consuming medical billing errors.
Tips to prevent medical billing Errors
For a medical practice to thrive and expand, it is vital to maintain the flow of revenue cycle management. A crucial aspect of achieving this is preventing medical billing mistakes that can adversely affect the practice’s financial health. The following are six common coding mistakes and effective prevention strategies for your practice.
Keep your knowledge fresh about coding
Due to frequent modifications in healthcare regulations, advancements in treatment options, and the discovery of new illnesses, codes undergo constant changes. It is crucial to stay updated with the latest billing codes and procedures as they emerge to ensure accuracy and compliance.
Learn to Bust the duplicate billing
To prevent errors, it’s essential to exercise caution and avoid billing for services multiple times. While it may seem straightforward, this mistake can occur when multiple individuals enter information. Thoroughly verifying each patient’s details is crucial to prevent any potential complications in the future.
Be cautious about under coding or Upcoding
Upcoding happens when codes are falsely included in a patient’s bill to increase the amount owed to a healthcare provider, even for services not received. On the other hand, under-coding involves intentionally omitting codes from a patient’s bill to evade an audit. To prevent these issues, comprehensive training and meticulous review procedures are crucial.
Do not forget the pre-authorization
Insurance-related problems are frequently the primary cause of claim denials. When a patient visits regularly, staff members may assume no changes have occurred with their insurance. However, failing to verify their eligibility can lead to complications if there have been any changes.
Follow deadlines
When meeting claim filing deadlines, it can be challenging to rectify late submissions. Timely filing denials pose the most difficult appeal process. To avoid missing these deadlines, maintain a comprehensive list of common filing requirements and conduct regular medical billing audits to prevent denials in the future. Utilize recurring reminders or calendar events to address this issue proactively.
Ensure that information is entered appropriately
 it is crucial to double-check the accuracy of the entered information. Mistakes can easily occur, especially when juggling multiple billing responsibilities. Here are some common errors to avoid, if possible:
- Entering ICD-10-CM codes with incorrect digit count
- Submitting incorrect CPT codes
- Providing incorrect information for insurance, patients, or providers (e.g., name, address, date of birth, policy numbers, etc.)
- Not submitting codes altogether in a claim
Final thoughts
Errors in medical billing can have detrimental effects on healthcare providers and patients alike, leading to financial setbacks and delayed treatment. Nevertheless, by adhering to these expert recommendations for preventing medical errors, providers can mitigate the likelihood of errors and allocate more time to delivering high-quality patient care.
