It is important that medical billing specialists minimize e-coding and processing errors when filing claims. Since majority of revenue for healthcare providers comes through processing of successful claims, even a single mistake can prove costly. So the number of denied as well as rejected claims should be kept at a minimum.
Before we get into the top five common billing errors, let us first understand the difference between denied and rejected claims. Denied claims are the ones that have been determined un-payable by the insurance companies. Claims get denied due to common billing errors or lack of information. However, they can also get denied on the basis of patient coverage. In some cases, denied claims can be appealed as well as reprocessed.
Rejected claims are the ones that get rejected by insurance companies because of errors. This happens when a billing specialist inputs the wrong insurance or patient information. Once the errors on rejected claims are amended by the biller, they can be resubmitted for processing with the insurance company.
Top 5 common errors in medical billing
Since billers have to process several claims in a day, it is possible that they miss out or overlook some parts of the claims.
These instances lead to denials or rejections. Some of the common mistakes or errors are:
- Entering wrong or incomplete information for the provider and patients. If information related to the patient’s name, date of birth or insurance ID isn’t correct, then it will lead to denials.
- Not entering the right information for insurance provider, such as address, policy number, and contact information and so on.
- Putting in the wrong code or confusing codes (CPTs, ICD-10 codes) also leads to denials.
- Claims shouldn’t have mismatched treatment and diagnostic codes. Also forgetting to put all codes for services performed by physician’s results in errors.
- Fifth common error is of duplicate billing which occurs when the same service has been billed more than once.
There are several other reasons why claims get denied. For instance, lack of verification of a patient’s insurance coverage, not having EOBs on denied claims and so on. Only when every piece of information on the claim is correct, it can be processed in the right manner. Correct codes need to be used and this is the main reason why every provider needs to hire a team of expert medical billers and coders.