Human Resource Management

HRM Guide World HRM Guide USA HRM Guide UK About HRM Guide Student HRM HR Updates Facebook
Search all of HRM Guide

Medical Billing Mistakes to Avoid Making in Your Practice

Medical Billing

October 4 2019 - Over 85% of the American population has contact with a healthcare professional at least once per year. While the average person doesn't know this, every time that a patient sees a provider like you, your office needs to submit medical billing claims to payers (typically insurance providers) to have your services reimbursed.

Being able to receive timely reimbursements is imperative to practices, particularly those that are just starting out. After all, if you have tens of thousands of dollars in backed up claims, you may not have the cash flow necessary to keep your business running.

To help you expedite your claims process, do your best to avoid these common billing errors:

1. Generalized Coding

When your medical billing team submits claims, it's important that they code procedures and services with the highest level of detail possible. Codes that don't communicate enough information to insurance providers have a much higher chance of getting sent back for additional information which can increase your payment time by weeks.

2. Late Claim Filings

In order to get an insurance provider to reimburse you for services, claims need to get filed within a year of the service's performance date. That turnaround time is much less than it used to be,  due to the Affordable Care Act.

If you miss your window for billing an insurer, your practice will have to write off the cost of performed services as a loss.

3. Claim Forms are Incomplete

There are several details that go into a successful reimbursement claim. Proper coding, a patient's identifier, and the date in which services were rendered are just a few of the elements that your billing team will be required to fill in.

If a detail is missed when a claim is submitted, you can expect that your patient's insurer will kick your claim back and request additional details. In many cases, insurers require painstaking accuracy in hopes of a claim getting lost in the shuffle and eventually getting written off by private medical practices.

4. Codes are Incorrect

There's a reason why billing and coding program completion is a requirement for medical billing professionals. That reason is that there are hundreds of thousands of code combinations that a billing professional can input to describe a condition to an insurance provider.

One wrong number after a decimal and a code will be incorrect. That will prompt insurance providers to kick back claims for review or deny them altogether.

While nobody is perfect, making sure that the billing professionals that you hire have a high attention to detail can go a long way in ensuring that error potential is reduced.

5. Upcoding

More medical practices than you can count have tried and have been punished for upcoding. Upcoding is when teams intentionally bill for a higher-paying codes.

In many cases, businesses get away with upcoding and when they don't, they claim that an error was made. If it's suspected that your medical practice routinely upcodes though, an insurer might stop allowing their clients to see you.

6. Misidentifying a Patient

Every patient has what's called a "patient identifier" which should be included in relevant billing documents. As with medical coding, there are a lot of opportunities to make a mistake when writing out a patient's identifier.

Attention to detail is paramount to minimize occurrences of misidentifying patients. If the mistake is caught early, an addendum can be submitted to insurance providers to help reduce turnaround time.

7. Duplicate Claims Get Submitted

Believe it or not, it's common for medical billing specialists to accidentally submit duplicate claims. Duplicate claims typically come about as a result of a billing team not noting that a claim has already been filed.

Another way that duplicate claims come about is when billing teams get asked for additional information by an insurance provider and rather than piggybacking on the existing claim, they file a new one.

8. Additional Documentation Is Not Submitted

Insurance providers routinely request additional information when managing reimbursements. In most cases, this additional information gets requested so your practice can prove the medical necessity of a procedure.

When more information gets requested for a claim, ensure that your billing team makes it a priority. It's easy for a claim that has gotten kicked back to end up low on a to-do list and eventually get forgotten.

9. Performing Services on a Patients With Bad or No Coverage

For both you and your patient's sake, before rendering services, check a patient's insurance. An insurance provider that you're familiar with may have changed their provisions recently. It may also be that your patient has fallen behind on payments and is no longer covered.

Requesting medical billing reimbursement on bad insurance is an impossibility. So, rather than getting an auto-rejection and having to chase down your patient with an invoice, be meticulousness in verifying coverage.

Attention to Detail Can Save You Tons of Medical Billing Time and Money

Medical billing comes down to knowing what you're doing and paying close attention to the process. If you have a well-trained team that cares enough about their work to ensure that claims are submitted to the best of their ability, you'll rarely run into problems.

If you don't have a team that ticks those boxes, get one.

There's a lot to know about the human-side of healthcare practices and a multitude of other businesses. To keep learning tips that can help you operate successfully, browse more of the newest content in our online publication.

More Health-Related Articles


HRM Guide makes minimal use of cookies, including some placed to facilitate features such as Google Search. By continuing to use the site you are agreeing to the use of cookies. Learn more here

HR Directory
Privacy Policy

Anything But Work
British Isles
Psychology Articles
Copyright © 1997-2024 Alan Price and HRM Guide contributors. All rights reserved.