Most Common Medical Billing Errors And How To Avoid Them

Errors in medical billing often arise from basic mistakes such as prior eligibility verification, typographical errors or errors in data entry. Unfortunately, even a simple error leads to a substantial delay in claim reimbursement. The lifeblood of a health care facility is weak by missed payments, which depend on continuous reimbursement. It is for health practitioners and coders to avoid such errors before they arise and interact effectively with the rest of their workers.

When dealing with medical bills, you need to eliminate processing or coding mistakes when making claims. Since healthcare service providers earn the largest proportion of their income from successful claim processing and payments, any errors you make can have a considerable affect on you and your employer.

5 Most Common Medical Billing Errors

In this guide, we will clarify different things you can do to prevent common medical billing mistakes made by medical billers and minimize the number of claims from getting rejected and denied!

1. Wrong Identity

Having the wrong patient ID number is a common medical mistake. If the front office staff gets wrong info or you enter it incorrectly in medical billing software, it will eventually be up to the medical biller to correct and resubmit any claims that have been rejected due to the wrong ID number. Taking the time to check patient eligibility and make sure all patient insurance ID number is right would save you from many headaches in the future.

2. Transposing Digits

As with entering the wrong ID number, transposing digits is easy. A thoughtless and straightforward switch of two numbers can lead to a rejection or denial of your claim and a severe delay in insurance processing and payments. Transposing the digits often happens when entering the patient’s dates of birth, so make sure you double-check all the numerical data before claims submission!

3. Claim sent to the wrong insurance

The wrong insurance company’s claim is one of the most prominent yet most superficial medical billing mistakes to prevent. That usually occurs if you are not provided with a copy of the insurance card or don’t pay any attention while entering patient insurance mailing address or payor ID. To avoid this common mistake, make sure the insurance provider has a copy on both sides of the board and that the front office workers can check the practice management system and choose the correct insurance agent.

4. Invalid diagnosis codes or procedure codes

Diagnostic codes and procedure codes are updated regularly. Hence, one of the regulations currently billed is likely to be changed or deleted sooner or later. If this occurs and you deny the invalid code, your claim will be rejected immediately by the billing software or clearing house. The best way to prevent this kind of mistake is to ensure that your coding books are still revised and that your commonly filed codes are reviewed every year to see if they have changed.

5. No Code Linkage

Simply put, the code linkage shows medical necessity by linking your diagnostic code to your procedure code. In other words, your condition needs to match your treatment. That indicates the confidence that the procedures performed by your doctor were medically appropriate and that they should be paid for them. If the code connection does not imply medical need, you will not be charged for the claim. The more you know about the procedures and diagnostic codes you set, the easier it will be for you to assess the code linkage on your claims, eliminating expensive and time-consuming mistakes on claims that should be charged first!

How to Prevent Medical Billing and Coding Errors

Medical billing errors mentioned above happen regularly. If you know what to look for, you can avoid these errors.

  • Pay attention to the details and verify any number of codes or irregular codes that you suspect may have made in error. Double-check the spelling of the patient’s name and all other personal information.
  • Always confirm the patient’s insurance information at each visit. Also, the requirements of the insurance company, such as pre-authorization of treatments and specialists. You should also be aware of co-pays, deductibles, maximum coverage, and limitations of visits.
  • Keep up-to-date with the latest laws and government regulations. To ensure that all claims are correct, an accurate understanding of medical coding guidelines is essential.
  • Inter-office communication is also a crucial part of medical billing. Ensure that the front desk knows how to enter patient and insurance details correctly would ensure that all charges are billed for incomplete information.
  • Also, ensuring that physicians and hospital personnel know the relevant coding guidelines would ensure that all procedures are conducted with recorded medical needs and correct code linkage. It also tends to minimize expensive and time-consuming mistakes and claims for appeals. If you have a question about a claim, make sure it has been answered correctly and promptly so that all of your claims go the right way for the first time!

Final Remarks About Common Medical Billing Errors

Medical billers are the first line of defense against medical billing fraud. If you notice repetitive errors and have concerns about fraud, please check the patient record notes with your provider. In some cases, medical billers are held liable for errors that result in medical billing fraud and abuse charges. These charges may lead to fines, penalties, and even prison time.

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