Common Medical Billing Errors and Tips to Reduce Them
This article discusses common medical billing errors and some important tips to reduce these errors.
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Patient billing and payment is important aspect for the financial health of an independent physician practice. Often, medical billing is regarded as a complicated process and getting through the process requires awareness about the potential risks involved. Medical billing errors can potentially cost physicians, clinics, physician groups and hospitals a lot of revenue per year. A professional medical billing and coding company would offer the services of a team of experts who are well aware about the latest technology trends to provide error-free procedures. Access Project, a Boston-based healthcare advocacy group, has found that up to 80% of all medical bills contain mistakes. In addition, Kaiser Health reported that $68 billion in lost healthcare spending can be attributed to medical billing mistakes. Potential errors in Medicare and Medicaid billing can result in the physician practice not being allowed to bill those entities for several years. At present, watchdog agencies, enforcement and penalties are on the rise, creating a highrisk environment for physicians. Rigid screening measures adopted by the Affordable Healthcare Act have resulted in about 17,000 providers losing their license to bill Medicare. Physicians are completely responsible for all the specific claims billed under their unique provider number and therefore a physician’s signature on any claims is held as verification of the accuracy and legitimacy of each claim. Increased scrutiny has prompted physicians and healthcare facilities to recruit certified employees and streamline their workflow. Common Medical Billing Errors Often, medical billing errors are typographical or data entry related. Such errors can create real problems for both patients and hospitals. Making even a simple mistake can lead to investing a significant amount of time tracking down the source of mistakes resulting in delays in payments. Effective communication between medical billers and coders is crucial to prevent these types of mistakes before they occur. The most common medical billing mistakes include – •
Missing information - Inaccurate or missing patient information or poorly documented patient encounters can trigger a claim denial. It is the sole responsibility of both the medical and billing staff to provide adequate information about a patient’s chronic conditions, test results, and exact details of a medical problem.
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Duplicate claims or services - Claims resubmitted for a single encounter on the same date by the same provider for the same beneficiary for the same service item (known as duplicates) are another major source of denials.
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Late submission – The claims can be denied if they come in after the payer’s time frame, even if the claims are accurate.
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Up-coding – In certain cases, providers may change an order that relatively costs less for an expensive medication/service. Verify whether the patients are being billed for a higher rate (even after that change) or being billed for both higher and lower rates.
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Not covered by payer – Medical billing denials for certain procedures not covered under patients’ current benefit plans can be avoided by checking details in the eligibility response or contacting the insurer before administering services.
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Messy writing – In some cases, medical practices and payers prefer handwritten claims, which can be a huge source of errors. If your staff’s handwriting is messy, it can be difficult to read patient information or claim codes.
Billing errors may be minimal in physician practices or clinics that depend on professional medical billing services. With the help of an established medical billing and coding company that offers the service of AAPC-certified coders who are up-to-date on the latest codes, healthcare providers can avoid these kinds of potential errors to a great extent. How to Reduce Billing Errors – Here Are Some Tips Preventing medical billing errors requires a team effort to ensure that all claims are dealt with properly in the first place. Adding more people to the healthcare claims management team won’t essentially help to reduce errors unless and until they clearly know what to focus on. Here are some important tips to reduce billing errors – •
Verify insurance benefits – Physician practices should perform insurance eligibility verification to understand patients’ eligibility for services. For each patient, it’s imperative to verify and check the correct insurance information and know coverage dates and allowed benefits including deductibles and co-payments.
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Verify patient information – Even small errors in patient’s name, birth date and gender can result in claim denial. If the patient is not the primary policy holder, the relationship to the policy holder should be checked for accuracy along with policy and group number.
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Keep clinical staff informed – The healthcare industry is changing. Medicare and Medicaid regulations as well as payment updates of private insurers undergo regular changes. Therefore independent physician practices need to conduct regular training regarding medical coding and billing updates and other payment related changes.
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Use technology – Features in electronic health record (EHR) systems help independent physicians automatically check for errors in billing even before the bill goes out. Maintaining accurate data in the EHR helps further prevent errors in patient information contained in claims.
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Be aware of trends – Physicians should be aware about the recent trends that may be occurring. Physicians should review billing errors on a regular basis and address the pattern of errors that occur with the staff so that they can be corrected and not repeated in future.
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Explanation of benefits (EOB) – Never lose the “Explanation of Benefits” (EOB) as it will help to keep track about the reasons for the denial.
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Time spent in the OR – The average time required to perform an operation is considered an important criterion for billing. Make sure that the patients are being charged accurately for the same.
Billing and coding errors may be committed either by mistake or purposely by physicians to get more money. However, the concerned physicians would be answerable for the same, if these errors are detected. Outsourcing medical billing is a practical strategy in order to avoid committing these errors.
www.outsourcestrategies.com
(800) 670 2809