Medical billing errors or blunders may sound like simple mistakes but they are reasons for major problems in the healthcare industry. Finding out these mistakes and avoiding them in time is important than ever.
Best of the best medical billing services can make mistakes but only a few have advanced in their practices to avoid and prevent them from happening again and again.
Medical Billing Blunders – Errors
An ideal medical practice needs a steady and reliable revenue stream in order to run it smoothly. Unfortunately, challenges in medical billing and errors in between may affect its success for a long time. Even if you are experiencing delayed payments, denials, customer complaints, or lost productivity; errors in medical billing hamper your practice. Reducing such errors is necessary to your bottom line, so it’s important to think about the most common medical billing errors/blunders and put measures to prevent them from impacting your revenue cycle management.
The real question is, what can a medical practice exactly do to avoid this from happening? What measures should be taken to make sure you create an accurate billing statement?
It’s always to know that you have an expert like 24/7 Medical Billing Services to put a list of common medical billing errors to keep your practice safe even if you are outsourcing medical billing to someone expert.
Incomplete Claim Information
An empty or unchecked box on a claim form can cause a denial. Even the most basic fields like gender, date of birth, and time of the accident or health emergency are usually left blank.
Make sure a second opinion offers a review of every document or electronic claim your office files to ensure the necessary fields are completed. If you are all right with e-claims, verify if your software system flags users to review missing fields and alerts for all required data before allowing them to submit.
Failing to Verify Insurance
Problems with insurance are on the top of the list for most claim denials. Usually, failing to verify stems from an overreliance on routine. If a patient admits to the office frequently, the staff may assume their insurance provider or coverage plan is the same and doesn’t check eligibility.
But since insurance data can be changed at any time, you must follow verification steps into the billing workflow for every single visit. This means checking for all 4 potential reasons is important for insurance related denial:
- Coverage terminated or ineligible on date of service.
- Services not authorized.
- Services not covered by the plan.
- Maximum benefits reached.
By implementing steps in your billing workflow that verifies the insurance at every patient visit, you are making sure that there are no policy-related issues that could result in denied claims.
Lack of Specifics
Many times, insurance carriers deny claims for not being coded to the top level of specificity. As a trained coder knows, every diagnosis needs to be coded to the most top-level for that code – meaning the most digits for the code.
If your staff is not particularly familiar with coding, they could keep making such kinds of errors usually without even realizing it. Getting educated is important: teach your billers what truncated codes are so they can fix them before filing.
Miscoding and Typing Errors
Simply, you might just get things wrong. If it’s an unbundled code, a duplicate charge, a typo in the patient name, or an incorrect date, even an accidental, honest mistake can affect an insurance claim. When you heavily focus on medical billing and coding particularly if you have other important tasks, errors are unavoidable. Here are a few of the most common ones to avoid if possible:
- Filling wrong information for insurance, patient, or provider (i.e., name, address, date of birth, policy numbers, etc.).
- Entering ICD-10-CM codes with digits with no limit.
- Not entering codes at all in a given claim.
- Submitting incorrect CPT codes.
Missed Filing Deadlines
Some payers mention two years of timely filling windows for standalone medical claims, wherein others may give you 30 days to file. If you miss filing a claim on time, you’re pretty much messed up. Filling denials in time are among the most difficult to appeal.
Eliminate Medical Billing Errors with 24/7 Medical Billing Services
The best way to avoid common errors is to work with well-trained agencies or professionals. One easy option is outsourcing medical billing, which is a proven way to help practices increase revenue by reducing claim denial rates. As an experienced medical billing and coding partner for hundreds of medical practices, 24/7 Medical Billing Services has been helping practices streamline their billing practices.
We have worked with various practices and EHR systems allowing us to put the best systems intact to help your office.
Learn more about how our billing experts work with your staff to reduce errors and boost your insurance reimbursements, get in touch with our team for a free consultation.