Six Common Billing Mistakes That Can Impact Your Payments

Thu, Nov 27, 2014 --

Reader Questions

Make a checklist of your most common denial reasons.

Often in medical billing, mistakes take place. However, if they are not addressed right away or if they’re overlooked, it could turn into a costly affair for the provider leading to potential revenue loss. If your practice is facing financial difficulties, it may be essential to assess your claims for the most common billing errors before billing your claims out.

billing mistakes

Here are six common mistakes that you should know to avoid a medical billing nightmare:

Not Verifying Insurance Coverage

One of the key reasons why medical billing claims are denied is failure to verify insurance coverage. Since insurance info can change anytime, it’s essential that the provider verify the member’s eligibility each time services are provided. The four common denials associated with insurance verification include members’ coverage terminated or not eligible for this date of service (DOS), services not authorized, services excluded by plan benefits, and maximum benefits met.

Inadequate Patient Information

Even the smallest inaccuracies in patient info can invite billing denials. So small details are essential to getting medical bills paid the first time. The front office staff can however help minimize denials by verifying details of the patient such as: is the physician NPI number on the claim correct? Is the patient’s name spelled the right way and is his date of birth and sex correct?

Is the insurance payer entered correct and is the policy number valid? Does the claim require a group number to be entered and is the policy number valid? Does the diagnosis code match the procedure performed and does the procedure code performed match the authorization obtained?

And for multiple insurances, is the primary insurance correct for coordination of benefits? Better, make a spreadsheet of your most common denial reasons and use that as your guide to creating a checklist.

Incorrect or Invalid Diagnosis or Procedure Codes

Insurance companies reject claims that are submitted for services that do not meet the medical necessity requirements. As such, it becomes imperative to choose the correct ICD-9 codes for the valid services and link them with associated CPT codes.

There are many reasons why the inappropriate diagnosis or procedure code could end up on the claim.

  • Outdated Coding Books: One needs to update coding books regularly; it can be expensive but not worth losing out on revenue due to needless denials.
  • Illegible Handwriting: Poor physician hand writing is one of the biggest reasons for billing errors. You could consider switching to an electronic health record (EHR) to avoid this.

Double & Unfair Billing

If the same procedure, test or treatment is billed more than once, it amounts to duplicate billing. Likewise, similar mistakes can be billing for the wrong service or billing for services never performed. These errors are most of the time due to simple human mistakes. Due to this many practices are fined each year for fraud.  One simple way to avoid inaccuracy in medical billing is performing chart audits.

Upcoding

Practices also lose money because of upcoding. Normally it occurs when a provider purposely uses a higher-paying code on the claim form to falsely reflect the use of a more expensive procedure or device than was actually used or was necessary. This type of Medicare/Medicaid fraud cost the taxpayers billions of dollars.

Unbundling

Unbundling is the practice of submitting bills in a fragmented fashion to maximize the reimbursement for various procedures that are required to be billed together and as such at a reduced cost.

barnalig@eliresearch.com'

About 

Barnali Gogoi is a medical coding and billing writer with over 7 years of experience in the industry. She holds a Masters Degree in English Literature from Gauhati University and a diploma in advertising and marketing from YMCA.

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