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

August 14, 2020 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. Unfortunately, that’s going to be challenging to achieve if your billing efforts aren’t optimized for success. Whether they incur delayed payments, denials, client complaints, or even lost productivity; medical billing blunders hurt your practice. Eliminating errors is critical to your bottom line, so it’s essential to think about the most common medical billing mistakes and put strategies to prevent them from impacting your revenue cycle management.

Top 5 Medical Billing Mistakes

1. Failure to Verify Insurance

Insurance issues are the top reason for most claim denials. Typically, failure to verify stems from an overreliance on routine. If a patient enters the office frequently, the staff may assume their 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 the plan.
  4. Maximum benefits reached.

By implementing a step in your billing workflow that verifies the patient’s insurance at every visit, you’re ensuring there are no policy-related issues that could result in denied claims.

2. Incomplete Claim Information

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

Make sure a second set of eyes provides (at minimum) a cursory review of each paper or electronic claim your office files to make sure the 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. 

3. Lack of Specifics

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.

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

4. Missed Filing Deadlines

Some payers have two-year “timely filing” windows for individual 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. A recurring reminder or calendar event can also serve as a helpful way of resolving this problem.

5. Miscoding and Typing Errors

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, even an accidental, honest mistake can be enough to derail an insurance claim. When you’re heavily involved in medical billing and coding—especially if you have other responsibilities, it’s easy to make a general error. Here are a few of the most common ones to avoid if possible:

  • Submitting wrong information for insurance, patient or provider (i.e., name, address, date of birth, policy numbers, etc.).
  • Entering ICD-10-CM codes with too many or too few digits.
  • Not entering codes at all in a given claim.
  • Submitting incorrect CPT codes.

5 Ways to Avoid Common Medical Billing Mistakes

1. Find and Eliminate Your Own Errors

Many medical billing problems that patients face have nothing to do with the provider and everything to do with their insurer, thanks to limited-coverage plans, high deductibles, and other issues. But sometimes, the problems lie squarely with you.

  • Is your billing department prone to errors, oversights, or poor timing?
  • Is your denial rate above average?
  • Are your billers spread too thin with other responsibilities around your office?

Pinpoint your areas of weakness and fix them right away. (Or, outsource your issues by contracting with a medical billing service – it may be more cost-effective).

2. Revisit Your Processes

Practices that don’t have formal medical billing policies often have holes or redundancies in their processes that confuse their patients. If you don’t have step-by-step procedures mapped out for your entire revenue cycle, you should develop and implement them. Start by creating a written medical billing policy guide right away. If you do have a policy in play, review your processes to make sure they’re up-to-date and helping you operate at optimal efficiency. 

3. Keep Up with Medical Billing and Coding Trends

Medical billing codes are constantly changing due to the many modifications in healthcare regulations, newly discovered illnesses, and newfound treatments. Therefore, it’s important to keep up-to-date with new billing codes and procedures as they arise. This ongoing awareness will significantly reduce the likelihood of medical coding errors.

4. Avoid Duplicate Billing

Another way to avoid medical billing problems is to be careful not to bill for services more than once. Although this may seem like a pretty self-explanatory task, it can happen very easily if more than one person is inputting information. It’s crucial to be thorough in verifying each patient’s billing to avoid future complications and incorrect medical billing.

5. Watch Out for Inadvertent Upcoding or Undercoding

Upcoding and undercoding are often done deliberately to financially benefit a practice in some way. Upcoding occurs when codes are entered into a patient’s bill for services that were not received—often to inflate the total amount owed to a provider. Undercoding is when codes are left out of a patient’s bill—often for the purposes of avoiding an audit.

Oh, did we forget to mention that both practices are illegal and can result in fines or criminal prosecution?

Unfortunately, there are also times when this form of incorrect medical billing occurs accidentally, not deliberately. This is common for anyone who is inexperienced with medical billing and coding, when office staff is overwhelmed with the number of claims they’re handling, or no one at your practice is keeping up with the most recent changes within the industry.

Medical Billing Mistakes and Your Patients

Your practice does a lot for your patients’ physical health, but are you doing anything for their financial health? Medical coding errors can cause a lot of headaches for patients, especially if they feel their provider isn’t doing enough to help them understand their bills and resolve medical billing errors that come up.

Not every practice is equipped to help patients resolve medical billing problems, due in part to budget shortages, staffing issues, or other factors. But if you’re looking to enhance your patients’ all-around experience with your practice, you’ll want to make sure your patients have an ally as they navigate the challenges of medical billing. 

As the business of healthcare becomes more value-based and patient-centric, some medical practices are incorporating “financial advocates” into their businesses to better serve their populations. An advocate’s duties involve helping your patients understand their health expenses – both out-of-pocket and through their health plans – and taking care of special issues like filing, auditing, or appealing problem claims upon patient request.

That may or may not be right for your practice but, at the very least, you must appoint someone in your office to be the go-to person for patient billing questions – rather than just let those calls roll to the back office for the next available person to handle. This “patient billing support” rep can be a member of your billing team or a knowledgeable clerical staffer who can act as a liaison between your patients and your medical billing service when it comes to dealing with medical billing problems.

Eliminate Medical Billing Errors with NCG Medical

The best way to avoid plain mistakes is to 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. As an experienced medical billing and coding partner, NCG Medical has been helping healthcare practices streamline their billing practices for over forty years. We’ve worked with a variety of practices and EHR systems, which allows us to put the best systems and policies in place to help your office increase its overall clean claims and maximize its revenue cycle management.

To learn more about how our billing and coding experts work with you and your staff to reduce medical errors and boost your insurance reimbursements, contact our team today for a free consultation.

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