5 Common Medical Billing Mistakes and How to Avoid Them

5 Common Medical Billing Mistakes and How to Avoid Them

Having an easy experience with medical billing requires knowing what will hinder your progress. Here are medical billing mistakes and how to avoid them.

Doctors in the U.S. lose a staggering $125 billion each year because of inconsistent billing practices. We’re all human, and everyone makes mistakes every once in a while. However, when it comes to medical billing mistakes, even the smallest mistakes can be incredibly detrimental to your healthcare practice.

Most billing mistakes lead to claim denials; in a classic lose-lose scenario for both you and the patient. Recently, billing mistakes in medical practices have increase manifold due to the introduction of new medical codes. Most coders have a hard time keeping up with the latest codes, which translates to more mistakes on top of mistakes.

Veteran coders are the most hard-hit by these new codes because the old codes are so ingrained in their way of work. However, that doesn’t mean you should dismiss all your hard-working veteran coders in favor of fresh recruits. That’s a decision you’ll most likely regret.

If you’re keen enough, and with the right tips, you can sidestep most, if not all, of these billing mistakes. In this post, we’ll be highlighting a few healthcare billing mistakes and how you can avoid them.

1. Coding Errors

Coding errors are the leading cause of most medical billing mistakes in centers across the country. Huge mistakes in coding could be very detrimental to your practice in terms of finances and patient relations. They could either lead to claim denials or even legal action for severe cases.

There are several types of coding errors, but these are the main types.

Undercoding/overcoding– Undercoding occurs when you fail to account for the full range of services and bill less. Overcoding is when you exaggerate the services rendered, leading to a higher bill. Extreme overcoding could result in legal tussles with the patient.

Mismatch– This is when two items in the bill don’t match, mostly the diagnosis and treatment. Patients can get really flustered when you ask them to pay for medication for illnesses they don’t have.  It’s also very illegal and can lead to hefty penalties.

Not verifying insurance– Not verifying insurance can lead to denied claims, which translates to heavy losses. Make a point of verifying patients’ insurance information before conducting any tests.

The only way you can sidestep coding errors is by being keen on your coding. That means you have to check and recheck everything to make sure everything is A-okay.  Although coding can get a tad tiring, recheck your codes to avoid making costly coding errors.

Also, ensure your staff always use the right modifiers to avoid wrong codes. Train them on the codes that you use, and let them ignore the defunct codes that you rarely use.

2. Insurance Legibility

As mentioned earlier, not verifying insurance is a major cause of billing mistakes in many healthcare centers.  In a bid to save time, some healthcare centers let the patients through without verifying their health insurance policies. A seemingly efficient move that could cost you a lot in the end.

To be on the safe side, make sure you verify patients’ insurance before rendering any services. Although there are no legal repercussions for not verifying insurance, the practice ends up losing a lot.

3. Patient Data Issues

Patient data issues are especially common in large practices with heavy patient traffic. Keeping up with all the patients can be challenging and lead to data discrepancies. Patient data issues can also occur when there’s a malware attack or hardware failure in the EHR system.

The problem with inconsistent patient data is that you may bill the wrong patient for the wrong disease. You may thus end up overcharging or undercharging the patient. Both are very detrimental to your medical practice.

To avoid patient data issues, make sure you double-check them before storing them on your electronic health records system to prevent data entry errors.  This includes checking the patient’s policy, name, medical history, and any other relevant information. If you lose your data due to a virus or hardware failure, you can consider data recovery options to retain your patient data integrity.

4. Billing the Wrong Payer

You’d think billing the wrong payer is impossible, but you’d be surprised how many practices bill the wrong payer. What seems like a no-brainer is actually a huge challenge for healthcare centers large and small.

Most billing issues are a result of patients giving the wrong policy information. You end up billing the wrong insurance provider for your services. Most patients do this obliviously, and it ends up costing you an arm and a leg.

You can sidestep this issue by always making sure you verifying insurance information at check-in. Alternatively, you can consider using medical billing software to automate this verification. With this software, you can avoid most of the common medical billing issues and also streamline workflow in your practice.

5. Failure to Review Clearinghouse Reports

No matter how busy your practice is, always make sure you take time to review clearinghouse reports. Reviewing these reports is a tiresome process, but manageable if you put your mind to it. This is the only way you can detect any problems with billing or claims.

Also, make sure you review clearinghouse reports as soon as you get them. The longer you take to review them, the worse these issues get, and the more costly it gets for you. This can be a huge setback, especially if you’re trying to reduce expenses.

You can avoid issues with clearinghouse repost by going through your clearinghouse reports when you get them. That way, you can pinpoint any issues and address them. Medical billing software can help you compile the reports, but can only do so much when it comes to reviewing them.

After reviewing a couple of reports, you’ll get an idea of where errors are most likely to occur. Do this consistently, and you can eliminate the mistakes altogether.

Wave Medical Billing Mistakes Goodbye

If you take the above tips to heart, you can say goodbye to most of the common medical billing mistakes. Remember, you need to train your staff on diligence and recruit the right coders for the best effect. Also, try your hand at a medical billing software and see how that works for you.

If you want the easy way out, you can outsource your billing. For professional, accurate, and expedient billing services, contact us today, and we’ll see to it.