Reasons for Persistent Errors in Medical Billing



This is chiefly due to the number of hands the bill goes through; the count roughly being close to 300 people that are involved in the billing process at some stage(billing specialists, coders, medical practitioners, administrators and insurance providers). There are numerous errors related to medical billing; patients are sometimes overcharged (charged for services not rendered) or double charged (charged for the same service twice). It is important to close these gaps and strive to negate the reasons for persistent errors in medical billing.

Avoid the following errors and shorten the revenue cycle to a great extent:

Inadequate demographics: This is one of the most common reasons for erroneous medical billing wherein either the patient information is deficient or has been inaccurately entered in the database. Lacking information could be the patients’ name, age, sex, date of birth, insurance ID information (policy nos.), contact information (phone no. and address), or the procedures and services rendered by a physician. It is essential to double check the demographic data before the patient leaves the facility.

Altering Codes: Another reason for errors is the entry of incorrect or missing CPT codes, point of service codes or ICD-10 codes which can create enormous errors in the billing process.

Lack of knowledge (changing rules and regulations): With the ever changing healthcare rules (e.g. ICD-9 to ICD-10), it is mandatory that apt training be given to providers to keep them abreast of the changes. Sometimes, if the software is not updated, or the accounts receiving department has not been updated with the new rules and regulations, it often causes errors which then take a long while to settle.

Technology: Electronic Medical Records (EMRs) are a boon; but as billing specialists are getting accustomed to new systems, it could take a while before errors are completely eliminated.

Insurance coverage: The medical billing specialist should check the insurance coverage of the patient as occasionally it changes even without the patients’ knowledge. Also check if the patient has opted for a payment (installment) plan to avoid confusions.

Duplicate billing: Sometimes, the patient has already paid for a service but has been billed again which creates slip-ups. The medical billing specialist should confirm with the physician if he/she notices a superfluous bill.

Following are reasons for errors which are beyond the medical billing specialists’ control:

Up-coding: Incorrect codes are entered in the patients’ bill for creating larger bills. For reasons unknown the physician or the coders do not enter codes for services rendered to the patient. Like up-coding, under coding is illegal too.

Improper documentation: Healthcare providers may submit a bill which cannot be understood by billers and coders, reasons being illegible handwriting or sloppy documentation. This leads to coders being unable to understand the codes relevant to the services rendered, thereby an entry of incorrect codes leads to incorrect billing.

Mistakes can be human errors or interpretations gone wrong. It is imperative to meticulously review and gather relevant information timely to avoid errors and delays. Co-ordination, double checking, follow-up of claims along with a regular update on billing and coding trends can avoid billing errors. One can also work with an account receivable partners to help out in such matters.

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