Errors in healthcare billing, such as typographical errors, errors in modifiers, errors in modifiers coding, and mistakes in eligibility verifications, can have significant consequences. Even minor errors can lead to claim denials, causing delays in reimbursement and potential financial loss for healthcare practices.
When healthcare practices face challenges in getting reimbursement for the treatments provided, they can find reassurance in careful billing or by partnering with reliable third-party medical billing services. This strategic move can lead to faster claims reimbursement and maximum revenue.
Role and Importance of patient education to minimize Medical billing Errors
Education is not just a tool but a powerful weapon in the fight against errors in medical billing. It empowers billing staff with knowledge of codes, insurance rules, and healthcare laws, enabling them to perform their jobs with 100 percent accuracy. This, in turn, ensures timely reimbursement for healthcare providers without disrupting the flow of healthcare practices.
Five most common mistakes to avoid in medical billing
Let’s spotlight the critical factors that can help prevent medical billing errors. We will also list the five most common medical billing errors and provide tips to avoid them.
Incorrect patient information
While it may seem like a small oversight, incorrect patient information can have significant consequences in medical billing. It can lead to claim denials, delayed payments, and even patient financial burdens. Therefore, the medical billing staff must pay attention to these basic steps and ensure accurate information is recorded.
The people who work at the front desk of a doctor’s office need to gather and check that all the details about patients are correct. This is important so the doctor can get paid by the patient’s insurance. If there are mistakes, the insurance might say no to paying, which means the doctor has to wait longer to get their money. Sometimes, patients might even get bills for the treatment cost their insurance should cover.
Duplicate Billing
One of the major errors related to medical billing is duplicate billing. It happens when the staff responsible for medical billing or the doctors submit a claim twice for the same service or treatment procedure. This not only results in financial loss for the healthcare provider but also negatively impacts their reputation in the eyes of the insurance company.
One of the major errors related to medical billing is duplicate billing. It happens when the staff responsible for medical billing or the doctors submit a claim twice for the same service or treatment procedure. This not only results in financial loss for the healthcare provider but also negatively impacts their reputation in the eyes of the insurance company.
Hospitals and the people who handle their bills need to adopt healthy measures to track when they send a bill to an insurance company and avoid sending the same bill twice.
Luckily, as more hospitals use healthcare technology to send bills to insurance companies, mistakes like these should happen less often.
Sending Claim To Irrelevant Insurance Provider
The most common medical billing mistake is submitting a claim to the wrong insurance company. Other common scenarios involve your staff dealing with billing, such as not providing an accurate mailing address or ignoring the Payor ID. To avoid such errors, front office staff must carefully check the practice management system and choose the right insurance provider. These are essential aspects of medical billing to ensure transparency.
Not providing training to staff regularly.
- Inadequate staff training is the primary reason for most medical billing errors. For instance:
- Front office staff dealing with patient information verification might need to correct the accurate patient bio and insurance data.
- Medical billing staff might need to be updated on the latest issues with upcoding and unbundling or provided with training programs to identify when they are doing so inappropriately.
Upcoding and unbundling
These errors occur accidentally but are entertained as a common source of insurance fraud.
Upcoding happens when using an inaccurate CPT code similar to the accurate procedure code to get a higher reimbursement rate than the actual rate. For instance, a doctor must perform a casual routine checkup, but the biller translates this treatment as an extended checkup. As a result, it will be counted as a higher reimbursement rate.
Unbundling happens when medical places break down one extensive procedure into smaller parts and charge for each part separately. For instance, cutting and stitching might be charged separately at different times, but if done together, they should be charged as one thing. Billing them separately can let medical billers ask for more money than they should.
How to Avoid Medical Billing Errors?
- Fill and submit the claim within the stipulated time.
- Keep your knowledge of medical billing trends current.
- When things get too complicated due to excessive work, choose the best medical billing company to shoulder the administrative burden.
- Double-check the claim before submitting it to the insurance companies.
- Maintain accurate Electronic health records.
- Make sure you are not submitting the claim for the same service again.
Conclusion
Medical billing specialists play a significant role in the success of any healthcare organization. Suppose we observe and maintain the reporting and accuracy throughout the medical billing process. In that case, healthcare providers might gain a lot.
Meanwhile, regular training for the in-house staff, following the best medical billing practices, keeping up with the latest industry trends, and partnering with the medical billing company can help achieve the best possible results.