Medical billing errors might seem like simple mistakes but they can cause major problems. Find out the biggest mistakes to look for and how to avoid them.
Medical Billing Errors
You’re in the office when you notice there’s a small error on a returned medical bill claim. You aren’t too worried, of course; it’s an honest mistake that can be fixed. Nothing to be afraid of…right?
Actually, having medical billing errors can be a big deal, and they’re becoming a common problem. In fact, a 2014 study established that almost half of all Medicare claims filed that year were erroneous.
Depending on the size of the problem, it could add to your processing time, cost you money, and even put you at risk of losing your position.
The question is, how exactly do you avoid this from happening? What sort of steps must you take to make sure you create an honest and accurate billing statement?
It’s good to know that you can take some measures so your statement reflects only the facts. We’ve put together a list of common medical billing errors to keep a close eye on, as well as ways to avoid them.
1. Incorrect Coding
As we all know, medical coding is a monster in its own right.
Each case that comes into the office has its own medical code. These codes are very specific, and are known to be written down to a decimal point.
For example, the codes “401.0” and “401.1” mean the difference between having benign and malignant hypertension.
With each number representing a particular medical condition (sometimes down to the hundredths place), it’s important that the numbers be precise. Unfortunately, this doesn’t always happen.
Mistakes like these are the fault of the practitioners, and it’s up to us to correct them. Knowing about this problem early on in the statement will help to correct the statement faster.
2. Late Claims
This is a simple and honest mistake, but one that should be avoided nonetheless.
Of course, there are many different types of medical insurance providers out there. Each provider gives you a window of time to submit your medical claim to them.
For example, if your client has the ACA (Affordable Care Act) your window of time is only a year (12 months), whereas other companies are known to give anywhere from 15 to 27 months.
In any case, if you aren’t aware of the time to submit your claim and it’s past the date, you may very well be denied.
To keep this from happening, find out how much time you have to submit your claim, and then try to submit it as soon as you can to guarantee it will go through.
3. Duplicate Claims
When two claims have been submitted for the same exact encounter, they are known as duplicate claims.
This is not a dramatically serious issue, but still one that should be avoided as it can postpone processing for your client.
To keep such happenings to a minimum, make sure you train your staff to double check all the files they submit.
Carrying out this simple measure may seem to make things move slower, but the good thing is that you will make fewer mistakes, and it will help to make processing smoother as a whole.
4. Missing/Incorrect Client Information
Missing client information is another common medical billing error.
It’s quite easy to add incorrect information about a client, especially when you are in a rushed medical environment where mistakes are all too prone to happen.
Missing information like the demographic code, the incorrect code for the plan, or even omitting the social security number are just a few things that could cause a patient’s claim to be rejected by their insurance company.
Luckily, there is a way to keep this from happening. Before submitting any claim, make sure to read through all the information on the patient’s file and see that it matches the information that you wrote down on the medical statement.
Again, although doing this “double check” method may seem to slow you down – and time is of the essence in the medical practice – it is better to check twice and be sure than to rush things and have to go through the rejection process.
5. A Denied vs A Rejected Claim
The difference between a denied claim and a rejected one is pretty important, as that is the difference between “just an error” and something more serious.
When a claim is rejected by the medical institution, it’s almost always because of actual errors. Of course, these errors can happen on both sides of the field, between either the institution or the insurance company, or both.
In the case of a rejected claim, one can correct the errors and resubmit, and (hopefully) that’s that.
When it comes to denied claims, it’s something entirely different.
A denied claim is one that has been determined by the insurance company to be unpayable. Of course, this could also be the cause of errors, but more than likely it’s because the insurance plan doesn’t cover it.
Now, your client is stuck at a crossroads: Either they try to resubmit the request and hope for the best, or they have to find another means of paying for it – which could include pulling from their own funds.
This is why it is always a good thing for your client to read and understand exactly what their coverage offers them so that they can know what the policy limitations are.
We Will Help You Avoid These Medical Billing Errors
Even after learning about how to deal with medical billing errors, you may still be a bit worried about dealing with them on your own. The good news is, you don’t have to.
Here at SAVI group, we make sure that your medical statements are processed fairly. We specialize in revenue cycle management, EMR management, denial management, and claims and payment processing.
Do you have any questions that you would like for us to answer? Simply give us a call. We’d be happy to handle any concerns you may have.