Revenue Cycle Management (RCM)

What are the most common errors when submitting claims?

Have you ever checked how accurate claims are being submitted by your medical billing department? Due to the complex medical coding system, it is not surprising that errors are possible. A small error may lead to denial which ultimately impacts overall practice revenue. Let’s discuss common errors when submitting claims in detail.

Every practice has a main goal to ensure the practice gets reimbursed for all services that are rendered. While achieving this goal, both system and human errors are sometimes unavoidable. As we are all aware that the entire medical billing process includes two major elements, this includes health and money. That is the main reason reducing any possible errors is important.

Common Errors when Submitting Claims:

Wrong demographic information

It is a very common and basic issue that happens while submitting claims. Feeding correct patient demographic details are very important like their Date of Birth, Gender, Insurance ID, etc.

Incorrect Provider Information on Claims

Incorrect provider information like address, NPI, etc. can lead to denied claims. Generally, billers focus on patient data while submitting claims, and they do not give priority to check provider details. It may happen in Group Physicians practice, billers have to keep eyes on treating physician details while submitting claims.

Wrong CPT Codes

Wrong medical codes such as CPT, HCPCS, or ICD or entering wrong details of the place of service codes, or attaching conflicting details to CPT or HCPCS codes, entering too many or less digits to HCPCS, ICD, CPT codes is the most common error may occur.

If your practice’s billing staff is not updated with the latest medical coding updates, then they may submit deleted or non-billable codes.

Claim not filed on time

If a proper claim is submitted, but it’s submitted out of the claims submission time frame of the insurance company, it may result in a denial. Medicare providers should be aware that the Affordable Care Act reduced the claims-submittal period from between 15 – 27 months down to 12 months. The start date for a Medicare claim is the ‘Date of Service’ was provided or the ‘from’ date on the claim form.

The claim must be sent to the appropriate Medicare claims processing contractor well in advance. A claim sent before to the end date but they received it after will lead to denial. It is important to understand the required supporting documentation to get proper reimbursement. Commercial payers and Medicare have different guidelines for claims submissions that are considered timely filings.

If your team is following up on claims on time then the chances are higher to get it paid. You can always check your reports to identify the percentage of denied claims and the reasons for denials. At all times, your team can check through the patient details, and any other details that are important to claim submissions.

To prevent claim submission issues, providers must avoid medical billing and coding errors. Ongoing continuing education programs and other informal training sessions can help to make sure that your staff is aware of the latest coding requirements and best practices.

Another way to improve your practice efficiency is by outsourcing medical billing to the right billing company. To know more you can connect with our medical billing experts.


Medical Billers and Coders

Catering to more than 40 specialties, Medical Billers and Coders (MBC) is proficient in handling services that range from revenue cycle management to ICD-10 testing solutions. The main goal of our organization is to assist physicians looking for billers and coders, at the same time help billing specialists looking for jobs, reach the right place.

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