Top Four Medical Billing Errors

by | October 16, 2019 | 2:16 pm

Billing errors are not only bad for patients but also for medical practices. It’s critically important for healthcare providers to minimize any coding and processing errors to increase their revenue.

Frequent claim denials and negligence may also trigger billing audits and investigations which may not only damage the HME/ DME’s reputation but even attract penalties and fines. With reports suggesting errors in 80% of medical bills, addressing these four medical billing errors becomes very critical.

  1. Incorrect Patient Information

Accuracy is the critical part of the medical billing process. Even slight technical errors like a typo can result in claim denials. Incorrect patient information, forgotten fields like sex, name, DOB, insurance ID number, omitted social security number, and incorrect healthcare and insurance provider information are common clerical errors in medical billing. Incomplete and sloppy documentation on part of the provider impairs patient’s accurate evaluation and inhibits a clear presentation of a patient’s case. To avoid such issues, the front office must initiate collecting patient information right from the start and develop processes to ensure accuracy at each step.

  • Upcoding

Upcoding is a fraudulent medical billing practice where a more severe diagnosis is reported to the insurance company than what occurred. It may be a result of clerical errors, confusion about proper billing standards, or even intentionally using incorrect billing codes to inflate bills. Either way, upcoding is illegal and can trigger fines and criminal prosecution.

  • Coding Errors

Entering confusing ICD-10, CPT or HPCS codes, using outdated or incorrect CPT and ICD codes with conflicting or confusing modifiers to HCPCS or CPT codes, incorrect entry of either too few or too many digits to an ICD, CPT or HCPCS codes can be major reasons for claim denial.

Since both procedure and diagnosis codes are updated annually, you must take time to train your staff to stay up-to-date. You may even maintain a cheat sheet for quick reference and update it as per the CMA website.

  • Duplicate Claim Submission

Duplicates occur due to human error, especially among practices that struggle with manpower issues. Duplicate claim submission is billing done for the same medical procedure or treatment more than once. This can happen by resubmitting a previously denied claim, without evaluating the actual cause of denial, and making corrections to it.

Take Control of Your Medical Billing Issues Today!

If you are handling your medical billing services and coding in-house and your medical billing errors or claim denials are surging, you may want to consider outsourcing to a medical billing partner. Medical billing handled by experienced professionals can reduce errors to 1%. A medical billing company helps reduce errors by implementing the latest technologies that automate billing processes, improve accuracy and cut down on time and administrative costs.

Analytix offers comprehensive and customized medical billing solutions that help DME and HME practices and businesses improve their collections and enhance client service. Additionally, we are HIPAA and ISO 27001 compliant and offer flexible engagement models.

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