An effective and efficient medical practice depends on solid billing practices that help promote better cash flow and improved Revenue Cycle Management. Unfortunately, achieving this can be challenging as medical billing is fraught with difficulty leading to errors and inconsistencies.
Medical bills and coding are often results of human errors or intentional abuse of the system. Regardless of the reason, even small mistakes can increase costs, taking away money from insurance companies and employers.
Read on as we discuss five common medical billing mistakes you need to avoid.
1. Miscoding and Typing Errors
It can refer to a mistake made with the spelling of a patient’s name, digits in the policy number, missing date of birth, or typographical errors in general. If the employee is involved in medical billing and coding or swamped with other responsibilities, it is easy to make an honest mistake. Even so, they can be costly and incorrect information leads to claim denials and delays in payment.
2. Duplicate and Wrong billing
Duplicate billing happens if a patient is billed for the same test, procedure, or treatment more than once. Examples of wrong billing include billing patients for wrong services or services that were never performed. Most duplicate billing happens because someone at the office or medical billing department failed to determine if the patient has already paid for the service. Such mistakes are common but should not be overlooked. They can negatively affect a medical practice in the following ways:
- Financial – billing errors can cost a healthcare facility lost time and wasteful spending.
- Risk of Penalties – A single complaint from even a simple issue can incur penalties for fraud.
- Reputation – Wrong and duplicate billing can negatively affect a medical practice’s standing among patients, fellow practices, and the community.
Upcoding happens if a provider used a wrong code that causes inflating a patient’s diagnosis to a more severe condition leading to a more expensive procedure or service a patient has received. While it often happens due to clerical error, others intentionally do upcoding. It can have a detrimental impact on the loyalty of medical practice’s clientele.
Some hospital billing codes are used for a group of procedures performed together. When these services are billed under different codes, improper coding occurred through “unbundling” or “fragmentation.” Unbundling billing codes can inflate a provider’s profits, resulting in higher reimbursements for various insurance providers.
While unbundling can sometimes happen due to simple errors, its consequences are severe and considered illegal. Fortunately, there are ways to avoid this, like staying up-to-date on billing and coding trends, newly-discovered illnesses and conditions, and new treatments. Additionally, allow employees to be updated on the new codes and billing procedures.
5. Failing to Verify Insurance
Failing to verify insurance is one of the reasons for claim denials. As insurance often changes, a medical practice needs to check or verify insurance each time a service is provided or implement a verification step into the billing workflow for every patient visit. It also means checking for potential reasons for insurance-related denial:
- Provided services are not authorized or covered by insurance plan.
- Insurance is terminated or no longer eligible.
- Maximum benefits reached.
Avoid Common Medical Billing Errors with AI-Care Medical Group’s Medical Billing Services
The process of medical billing is typically challenging and demanding, which can be especially hard on medical practitioners who do not have access to the required skilled manpower in performing billing tasks properly.
It is an excellent option to outsource medical billing as it prevents errors and provides numerous benefits for your medical practice. AI-Care Medical Group is a trusted provider of medical billing services with their highly experienced in-house team of medical billing professionals.
Visit their website at www.ai-caremedicalgroupinc.com to learn more.