Common Medical Billing Errors And How To Address Them

COVID-19 appears to be finally under control, but the damage has been done; in addition to the number of deaths and the collapse of our healthcare system, the pandemic has left more than half of American families with some medical debt.

Some of these families may have higher debts than they should, as medical billing errors are frighteningly common. A few years ago, the Medical Billing Advocates of America stated that 80% of all bills issued by healthcare facilities in the United States would have minor errors. At the time, the organization found errors in three out of four medical bills they review.

How can this happen at a time when technology has streamlined many processes and eliminated (or at least reduced) the possibility of human error? Let’s take a look at the main causes of medical billing errors and also some ways you can minimize them in your medical clinic or private practice.

Erroneous or Incomplete Patient Information

Popular wisdom teaches us that what starts wrong ends up wrong. How do you expect your billing process to run smoothly if you don’t start by ensuring that all patient information is correct?

Accurate patient info is the basis of efficient billing claims and payment processing, as the failure to collect proper patient information can result in denied claims.

Your team needs to understand the importance of collecting this data upfront and know that it is not just formality or bureaucracy. The patient’s insurance information needs to be checked at every appointment, along with their personal info.

Did the patient change jobs or get divorced recently? Perhaps their address or insurance coverage has changed. Some people may have also changed their insurance plan to a more popular one and thus lost coverage for certain procedures.

Make sure your staff collects/verifies all patient information at each visit – from the insurance policy number to the person’s current address and phone number.

Upcoding

After a patient leaves the doctor’s office, each medical test or procedure performed is transformed into its respective Current Procedural Terminology (CPT) code for the billing process.

Upcoding happens when a bill is submitted with a higher value than the service performed simply because the wrong code was entered. Sometimes this happens by mistake, but there are cases where the “error” was intentional to charge more.

This is very serious and difficult to detect because similar processes can have different codes that represent a difference of thousands of dollars. For example, a heart failure procedure has its code and amount of value, but a more severe and complicated acute heart failure procedure has another code and costs much more.

Hospitals and clinics often employ specialized coding specialists. Having proper coding certification in place and updating your team regarding the new codes can avoid these errors.

Double Billing

In commerce, double billing happens when, by mistake, a customer is billed twice for the same service. In healthcare, sometimes the same bill is sent two or more times for a procedure performed only once.

Most of the time, it’s a simple mistake, but it can also be a fraud. Two providers may be trying to get paid for services to the same patient. Or a provider sends the same bill to both Medicaid and the patient’s private insurance company.

Insurance payers check claims deeply to avoid this type of mistake/fraud. As the owner or manager of a healthcare facility, you have responsibilities for the billing system. Cases of double billing, even by accident, can result in claim denials and negatively affect your reputation in the market – and consequently, your revenue.

How to Prevent Common Medical Billing Errors

Insurance billing is the main source of revenue for any healthcare facility. It is essential to prevent the most common medical billing errors.

Bottom line, these are some simple strategies that can improve your billing process:

  • Check all patient data before each appointment, especially their insurance coverage.
  • Make sure your team double-checks all patient/insurance/coding information.
  • Avoid duplicate billing by keeping all the different professionals working on inputting information on the same page.
  • Be strict about upcoding/under coding errors. Assess the possibility that your coding team is overloaded.
  • Keep your team up-to-date with medical billing and coding trends, as they constantly change with new diseases (such as COVID-19) and changes in healthcare regulations.
  • Track claim denials closely. Try to identify the reasons for what happened and address them next time.
  • Adopt revenue cycle management customized to a hospital’s needs, as this can help reduce or eliminate medical billing issues. Explain to the team what is revenue cycle management in medical billing and its importance.

Small Errors That Can Cost a Lot

As the owner or manager of a healthcare facility, you already have your hands full. That’s why it is essential to minimize medical billing errors to avoid claim denials or patients who refuse to pay their bills.

The patients themselves are more aware and concerned: in 2020, 49% of the Americans who answered a survey said they try to get to know their payment options before getting any healthcare. All billing process steps, from medical coding to collecting all the patient insurance data, should be done carefully. The simplest of mistakes can delay payments and cost you a lot at the end of the run.

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