In light of their heavy workloads, even the most contentious of medical administrators can easily make a mistake when processing a billing claim. This makes it all the more important to find a professional billing services company that excels in the unique intricacies of medical collections and full revenue cycle practice management.
Learning to Identify Common Errors Can Help Billing Professionals Avoid Them
Make sure you avoid the costly errors that regularly lead to falsely denied and fraudulently rejected claims. According to the independent industry resource Medical Billing and Coding Online, medical billing errors are becoming more and more common. Medical Billing and Coding goes on to explain that billing specialists will be far better equipped to prevent inconsistencies and problems if they learn how to recognize the errors that are committed most often. These common errors include:
Entering incorrect information for the patient, medical provider, and/or insurance provider.
- Inputting incorrect codes or confusing various types of codes (for example, mixing up CPT codes, ICD-10-CM codes, and/or point of service codes).
- Inputting too few or too many digits when entering ICD-10-CM codes.
- Failing to input specific codes for the corresponding services that are performed by a doctor or another healthcare official.
The Most Common Procedural Medical Billing Errors
Although many of the most common billing errors can occur as a result of a simple mistake while inputting data, the causes other problems are considerably more difficult to pinpoint and protect against. Industry experts have identified the following errors as among the most frequent and, therefore, the most costly to today’s medical system:
Duplicate Billing - Patients are often surprised to discover duplicate charges on their itemized medical bills. This can occur with multiple individuals (for example a doctor and a nurse) bill for the same service. It is also possible to bill a patient twice for the same at service at different stages of the medical process (For example, a medication charge can post to an account both when it is prescribed and when it is administered.
- Lack of Medical Information - If a care provider provides insufficient information about a diagnosis, a coder may input an incorrect medical diagnosis code. This can result in a “lack of medical necessity” verdict by the issuing health insurance provider.
- Upcoding - Upcoding occurs when a provider of medical services improperly changes patient’s diagnosis or treatment to one that is more serious and, therefore, more expensive. This can result in a significantly inflated bill.
- Unbundling - This term defines cases in which two or more charges that should have been billed under the same procedure code are instead separated into different, distinct procedures. Because package rates are generally much lower, unbundling typically increases the overall cost to the patient and/or insurance provider.
- Mismatched Treatment/Diagnosis Codes - When a billing specialist or another individual upcodes a diagnosis, but fails to change its corresponding treatment, the insurance company will not only face an inflated bill but also typically reject the claim.
- Balance Billing - Balance billing occurs when a health care provider saddles a patient with charges above and beyond their co-payments, co-insurance, and any other routine financial obligations as stipulated by his or her insurance policy. This issue is most commonly associated with in-network hospital or physician services that are mistaken for emergency care or other services that fall out of network.
FWorking with solo physicians in private practice, group practices, multi-site medical organizations, multi-specialty clinics, and hospitals of all sizes, M-Scribe Technologies can help you eliminate these common medical billing, coding, and documentation errors while simultaneously protecting you against others that are not so common. For more information or to schedule a free medical billing analysis, contact an M-Scribe representative by phone at 888-727-4234 or by email at email@example.com.