Medical Billing ServicesRevenue Cycle Management (RCM)

5 Common Medical Billing Errors to Avoid

In the medical billing and coding world- any error can turn out to be a costly affair. It is a well-known fact that healthcare providers receive the largest percentage of their revenue through processing successful claims. One wrongly spelled name, one transposed digit, a badly written documentation, can have a domino effect when filing claims. Hence to help aid in minimizing rejected and denied claims, certain steps and back-checks are very essential. Remember the old adage – Haste makes Waste! – And we wouldn’t want all those efforts to lead to loss of revenue.

Here are some 5 common medical billing errors to be aware of & avoid:

1. Wrong or misspelled information:

This could be disastrous for the patient or insurance provider. Misspelled names, wrongly entered Insurance identification number, or even inaccurate patient name can lead to rejection or denial of claims which would mean a loss of revenue affecting the Revenue Cycle Management process

Solution: Don’t accept forms blindly, but run a check to ascertain that all basic information has been properly entered

2. Verification of Insurance coverage:

This is very essential at the initial stage, even before filling in the patient’s name. Here the front office needs to be very vigilant about the patient’s insurance coverage.

Solution: Double-check with the front office and verify member’s eligibility insurance coverage every time service is provided as coverage can be terminated or change

3. Transposed or invalid diagnosis code:

Inputting an invalid code for Diagnosis and/or procedure can lead to claims be denied and/or rejected. Codes for both are updated annually, so great attention has to be paid when one bill for codes commonly employed in your practice as they may change or be deleted.

Solution: Always ensure one has the most updated version of the coding books, and recheck the commonly billed codes every quarter/year.

4. Billing wrongfully for medical services:

This could be in the form of either billing for the same procedure more than once or for services never performed. Errors happen in billing when a procedure or test has been cancelled, and the patient is still billed. This could also lead to what is known as upcoding or unbundling and could rebound by paying a penalty or even be taken as committing fraud

Solution: Perform simple chart audits to ensure all parts of a claim are billed correctly.

5. Documentation:

This in very essential in any healthcare service provided – be it at a specialist provider’s clinic or a hospital or even when providing ambulatory service. Documenting every aspect of the service provide to the smallest detail is essential for coders and billers to avoid all the above mistakes

Solution: Being Meticulous and diligence and conducting the medical billing process with great vigilance is very essential to minimize errors and make the medical claims process effective and efficient.

Thus, being aware of the nuances like knowing the difference between rejected and denied claims, and knowing the simple slips or errors that can be made –  can help avoid or at least minimize errors to facilitate a healthy and effective Revenue Cycle Management (RCM) process.

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