Medical billing mistakes can cost the healthcare business billions of dollars in wasted time and unnecessary expenditure. Errors result in insurance companies delaying payments, rejecting claims, and increased stress at a time when a patient needs to be worry-free. If mistakes are frequent or expensive, they may even cause patients to leave the clinic. Effective billing processes improve cash flow, revenue cycle management, or RCM.
Top Errors in Medical Billing
A look at the most common mistakes in medical billing and how to prevent them is provided here.
One of the most critical responsibilities of the front desk is to make sure that all guests have proper insurance coverage. As plans change often or people max out their range, this must be done every visit. Although it might be challenging to explain to patients that they may be charged for the treatment, dealing with an unhappy patient who gets an unexpected bill is considered preferable.
- Lack of Attention to Detail
The accuracy of patient forms may be improved by having them filled out online, and billing employees require uninterrupted time to accomplish their tasks. It is possible to have a claim dismissed based on a mind-boggling variety of apparently insignificant factors. Patients’ bad handwriting or an office worker’s inability to focus on data entry might be to blame.
Medical practitioners are having difficulty maintaining the accuracy of their billing claims since the number of coding options has recently increased. A code must be assigned that corresponds perfectly to the operation carried out and is coded to the most significant level possible for each diagnosis. This challenging part of the billing process requires a well-versed billing team with access to the most up-to-date codes.
The billing department may get an inadequate description from a provider, or treatment may be canceled without informing everyone on the team. If a bill is sent out wrongly or unnecessarily, it might be more complicated. Days might be busier than others in even the most meticulous medical offices.
Any number of things may happen to cause papers to be overlooked. Unfortunately, the practice must either bear this expense or face a patient’s wrath since it is too late to be reimbursed by the insurance company when the mistake is detected. Rejected claims that are not resubmitted quickly cost the practice money.
Human mistake is almost always at blame when it comes to bill duplicates. An unknowing clerk may mistakenly submit another claim, or an appointment may be rescheduled but still show up twice in the patient’s records because the billing clerk failed to detect that a lawsuit had already been made. A clerk may misunderstand the distinction between the two procedures and assign them the same code.
Consequently, the total claim is more significant than it would have been under the bundled code if the services had been invoiced separately.
One such critical oversight is the inability to maintain and periodically review a receivables aging report. To encourage the completion of follow-up actions, this shows unresolved claims. Because of suspected fraud on the patient or staff malfeasance, medical practices must be on the watch for intended errors.
- Failure to Verify Insurance
Insurance plans often change, even for the most loyal customers; therefore, a clinic must always verify adequate insurance coverage before providing treatment. Expired benefits, canceled or no longer eligible insurance, and services not authorized or covered by the plan are all instances of typical rejections. It is possible to save time, money, and effort by using several software programs that assist with these tasks.
- Using Wrong Diagnosis or Procedure Codes
Claim coding errors occur when the incorrect diagnostic or procedure code is used to submit a claim. Handwriting mistakes and the usage of out-of-date regulations are among the possible causes. Medical records may be more accurate and error-free if kept electronically rather than on paper (EHR).
