Nowadays, the pace of medical practices is getting very fast, and that is why the commitment to common and even simple mistakes is becoming very usual. Sometimes these simple yet common mistakes can be very expensive for a medical practice. These mistakes occur because medical staff is more into patient care.
After all, this is what they are supposed to do. Due to this, they sometimes neglect medical billing, and this negligence causes expensive medical billing mistakes. Unfortunately, these mistakes negatively affect the revenue of the medical practice.
In order to avoid these mistakes, you can always take the help of medical billing specialist and outsource your practice’s billing process from medical billing companies.
The expert medical billers and coders of medical billing companies, like UControl Billing, are aware of the errors with hospital medical billing. As they are aware of them, they tend to avoid these expensive medical billing mistakes. They also save your staff’s time and help increase the profitability of a practice.
Outsourcing medical billing services are beneficial because their medical billing specialists have expertise and capabilities that enable a practice to achieve every last dollar in order to grow and become successful.
Expensive Medical Billing Mistakes
Failure to Verify Insurance
The most common and top reason for medical claim denials is the disability to verify insurance. The insurance of patients who regularly visit a practice also often changes, and this is why the insurance of patients should be verified every time they come for a visit.
In these types of mistakes, most denials occur because the services are not covered or authorized by the plan. Sometimes the insurance is already terminated and is no longer eligible, yet the practice provides maximum benefits. This results in a loss of revenue; therefore, if you want to avoid this loss, ensure that the medical billing staff of your practice understand how important it is to verify every patient’s insurance.
Following are the things that should be verified:
- Effective dates
- coverage period
In order to save your practice’s valuable money, labor as well as time, you can always outsource from a medical billing company!
Incomplete or Incorrect Patient Information
Another very common reason for denials is errors and inaccuracy, which usually occurs during the process of patient registration. This includes errors like a misspelling of a name, incorrect date of birth, or wrong diagnosis code. Small errors like these can be the reason for delayed reimbursement or claim denials.
In order to ensure that the payment is made during the first time, make sure that the front office staff of your practice double-check all the patient details. In addition, ask your staff to verify insurance coverage and benefits as soon as the patient makes a call to schedule an appointment.
Here are the errors that a medical billing specialist should avoid:
- Incorrect patient information
- Sex, name, DOB, insurance ID number, etc.
- Incorrect provider information
- Address, name, contact information, etc.
- Incorrect insurance provider information
- Wrong policy number, address, etc
- Using Wrong Diagnosis or Procedure Code
Most of the coding errors are caused when a medical claim with the incorrect diagnosis or procedure code is submitted to the insurer or the payer. This error can occur due to several reasons, including handwriting mistakes or utilizing codes that are now outdated.
If you want to avoid this sort of mistake and improve your accuracy, switching from a traditional or paper-based system to advanced softwares or an electronic health record (EHR) could be helpful. You can outsource medical billing services from a third party as well.
Inaccurate or Duplicate Billing
Duplicating billing occurs when a practice bills more than once for the same treatment, procedure, or test. For Instance, let us say that a patient’s procedure or test gets canceled, but it was never eradicated from their account, then the practice will be billed for the service that was not performed.
These sorts of errors are usually considered mistakes or human errors. In order to avoid this sort of happenings, a medical practice should regularly audit their charts in order to ensure that all claims are accurately billed.
If a provider or a practice intentionally misses out on a procedural code from a superbill or codes for an extensive or less serious procedure than what the patient has actually received, then this process is called Undercoding. It may be done in order to avoid medical audits for some specific type of procedure, and another reason might be to save patients money. It should be noted that the process is illegal and considered medical fraud.
Similar to undercoding, upcoding is also considered a medical fraud. In this sort of fraud, the provider or the practice intentionally shows that they have performed a procedure, test, or treatment that they actually have not performed on a patient.
In this sort of error, a practice enters codes for those services that the patient has actually not received or sometimes enters codes for an intensive procedure that the provider has not performed. This type of coding is usually performed in order to get more money from an insurer or the payer. Upcoding is like undercoding, and this implies that it is also a fraudulent practice that should immediately be noted and reported.
Some medical practices have medical billing codes specially designed to be utilized for a number of procedures that are often performed together. And when these sorts of services or procedures are coded or billed under separate codes, then it is called unbundling.
One should know that like undercoding and upcoding, unbundling is also an illegal process as this sort of coding also brings profit for the medical practice, even when it happens because of a simple mistake. It should be noted that unbundling consequences can be severe.
The good news is that your practice can avoid the mistakes of undercoding, upcoding, and unbundling mistakes. In order to avoid such errors, a medical practice should keep its billing and coding trends updated. Medical billing codes keep on changing constantly, and therefore, to abide by updated healthcare regulations, new treatments, newly-discovered illnesses, new health conditions, a practice should provide its staff the resources to stay updated on all new codes and billing procedures. This is time-consuming, so one should try to take the help of medical billing specialists of some medical billing company in order to save time, money, and legal headaches in the long run.
How to Prevent Medical Billing Errors?
Medical billing errors that we have mentioned above are some expensive errors that can cost a medical practice a fortune. These errors should be avoided or prevented in order to run the practice successfully. Now that you have the knowledge of the errors that can bring you down, you can try to avoid them.
Here are some of the ways to prevent these errors:
- Pay attention to the patient information and verify their insurance plan coverage.
- Double-check the spelling of the name of the patient and all other personal information.
- Double-check codes or irregular codes that look suspicious.
- Perform pre-authorization of treatments and specialists at each visit of the patient.
- Stay aware of maximum coverage, deductibles, co-pays, and limitations of visits.
- Stay updated with the latest laws and government regulations.
- Try to abide by medical code guidelines.
- Ensure that the front desk staff has the knowledge of entering accurate patient and insurance details.
Outsource Medical Billing Services
One of the most effective ways of avoiding medical billing errors is outsourcing medical billing from medical billing specialists who have proven expertise and knowledge. UControl Billing is one such medical billing company with the best and most experienced medical billing staff that ensures that all things are managed well and that no errors have been made. To get benefits from their medical billing experts, visit their website now!