Top 5 Medical Billing Mistakes (and How to Avoid Them)

September 30, 2014 by Antonio Arias, MBA, CHBME

Topics: Medical Billing, Revenue Cycle Management

Running a cost-effective, efficient medical practice requires a steady and reliable revenue stream… and that’s something you can’t achieve if your billing efforts aren’t optimized for success.

Whether they incur delayed payments, denials, client complaints, or even just lost productivity, medical billing blunders hurt your practice. Eliminating errors is critical to your bottom line, so follow our tips to make your billing efforts more effective.

You fail to verify insurance

Insurance issues are the top reason for most claim denials. Typically, failure to verify stems from reliance on routine: a patient comes in frequently, so the staff assumes the insurance provider or coverage plan hasn’t changed and doesn’t check eligibility.

But since insurance information can change at any time, you must implement a verification step into the billing workflow for every single patient visit. This means checking for all four potential reasons for insurance-related denial:

  1. Coverage terminated or otherwise ineligible on date of service
  2. Services not authorized
  3. Services not covered by plan
  4. Maximum benefits reached

You file an incomplete claim

A single empty or unchecked box on a claim can be all it takes to incur a denial. Even the most basic fields like gender, date of birth, and date of accident or medical emergency are commonly left blank.

Make sure a second set of eyes provides (at minimum) a cursory review of each and every paper or electronic claim your office files to make sure required fields are completed. If you’re only working with e-claims, check that your software system flags users to review missing fields and input all required info before allowing them to submit. 

You aren’t specific enough

Insurance carriers often deny claims for not being coded to the highest level of specificity or for being “truncated” (unnecessarily or inaccurately shortened). As a trained coder knows, each diagnosis must be coded to the absolute highest level for that code – meaning the maximum number of digits for the code being used.

 If your billers are not highly familiar with coding, they could be making this kind of error frequently without even realizing it. Education is key: teach your billers what truncated codes look like so they can fix them before filing.

You miss filing deadlines

Some payers have two-year “timely filing” windows for certain types of medical claims, whereas others give you just 30 days to file. If you fail to file a claim on time, you’re pretty much out of luck… timely filing denials are among the most difficult to appeal.

Keep a list of your most common payers’ deadlines handy in the billing office of your practice and incorporate it into the organization of your team’s “to-do” lists. Audit unfiled claims frequently to make sure none of them slip through the cracks.

You miscode or improperly bill

Simply put, sometimes you just get things wrong. Whether it’s an unbundled code, a duplicate charge, a miskeyed patient name, or an incorrect date… an error’s an error.

The best way to avoid plain old mistakes? Work with well-trained professionals. One option is outsourced medical billing, which is proven to help medical practices maximize revenue by lowering claim denial rates.

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