Common medical billing and coding errors

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Has your medical practice seen a steady loss in revenue? Have you found the cause of your revenue losses?

If not, you may need to investigate your account receivables to see if and why your claims were denied or rejected.

Since most of your revenue comes from successfully-filed claims, it is imperative your billing specialists file, and code claims correctly.

Consider reviewing your claims for the following common billing and coding errors to ensure your claims are successfully processed, and your practice sees its maximum revenue potential.

Incorrect or Inaccurate Patient Information

From misspelled patients’ names to transposed policy numbers, even the smallest mistake in the patient’s insurance information can lead to a denial.

Any discrepancies should always be verified with the patient before filing their claim, as it can be the difference between a successful or denied claim.

Also, consider switching from hand-written new patient forms to electronic forms to avoid incorrect information due to illegible handwriting.

Not Verifying Insurance Coverage

A common misconception with insurance coverage is it can only change at the beginning of each calendar year.

Although this is true, this is certainly not the only time a patient’s insurance policy can change.

Life changes, such as a marriage, new dependent, and new employer, can change a patient’s insurance coverage at any time of the year.

Also, the type of coverage can change without the patient’s knowledge, including certain services that may not be authorized or covered through their policy, or they may have reached their maximum coverage.

Because of these reasons, it is essential your practice verifies their patient’s insurance coverage each time services are provided.

Incorrect Diagnosis and Treatment Codes

Claim codes let the insurance know the symptoms, illness, diagnosis, and treatment provided for their patients.

When claims are coded incorrectly, the patient’s diagnosis may not match up with the proper authorized treatment options, leading to a denied claim.

To avoid these errors, be sure your practice is using the most up-to-date coding trends. Also, consider switching from hand-written records to electronic medical records (EMR), as illegible physician handwriting can lead to incorrect records as well.

Duplicate Billing

Duplicate billing is when a patient is billed for the same service more than once. This type of billing takes place when a patient’s appointment is rescheduled or canceled, but their originally-scheduled services remain in the system.

Also, duplicate billing can happen when the practice bills a patient without verifying if they have already paid for services.

You can mitigate duplicate billing by implementing a charge tracking mechanism and performing routine chart audits. These two processes can help catch suspicious charges immediately and long before claims are submitted.

Upcoding and Undercoding

Upcoding is when a physician bills a patient for services that were not performed. It can also be for services that were labeled as an incorrect service that carries a higher reimbursement rate.

Undercoding is when a physician leaves out services performed to avoid audits or to lower a patient’s out-of-pocket costs.

Both upcoding and undercoding are illegal. They can carry fines and legal repercussions if the practice is found to have performed these actions intentionally.

We Can Help!

If you have any further questions regarding billing and coding errors or want to schedule a third-party audit of your billing processes, contact us today!

Let us take care of your business, so you can get back to taking care of your patients.

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