{"id":353,"date":"2011-09-23T07:57:30","date_gmt":"2011-09-23T07:57:30","guid":{"rendered":"http:\/\/www.medicalbillersandcodersblog.com\/?p=353"},"modified":"2025-05-20T10:02:57","modified_gmt":"2025-05-20T10:02:57","slug":"decoding-common-billing-blunders-devising-ways-to-quell-them","status":"publish","type":"post","link":"https:\/\/www.medicalbillersandcoders.com\/blog\/decoding-common-billing-blunders-devising-ways-to-quell-them\/","title":{"rendered":"Decoding Common Billing Blunders &#038; Devising Ways To Quell Them"},"content":{"rendered":"<p style=\"text-align: justify;\">The growing incidence of delays, denials, audits, and resubmission of physicians\u2019 medical bill claims is reason enough to have a relook at the way physicians\u2019 services are billed and coded. In a medical insurance environment, characterized by stringent billing and coding compliance, inherent billing and coding errors are easy to catch. Further, lack of knowledge or negligence can be no excuse as payers go by the set rules that govern medical bill reimbursements.<\/p>\n<p style=\"text-align: justify;\">As physicians try to figure out lacunae in their billing and coding practice, researchers have traced the reasons to lack of knowledge, negligence, outdated coding knowledge (physicians still trust what they learned 10 years ago!), inadequate in-house billing and coding competence, and, sometimes, incompetent <a href=\"https:\/\/www.medicalbillersandcoders.com\/medical-billing-outsourcing.aspx\">outsourced billing and coding solutions<\/a>. Delving further, they have even identified patterns of usual billing blunders.<\/p>\n<ul style=\"text-align: justify;\">\n<li style=\"list-style-type: none;\">\n<ul>\n<li><strong>Failure to document services billed:<\/strong> A common error, physicians often forget to bill for incidental services while addressing the main medical disorder, which can substantially reduce the final realization. Therefore, physicians should realize the importance of billing for medically necessary, though incidental, services also.<\/li>\n<li><strong>Failure to provide signatures:<\/strong> There have been instances of medical claims being returned unpaid and to-be-resubmitted again on account of omission of signatures by the physicians billing for their medical services. As physicians\u2019 signatures only can validate the medical services that are billed for reimbursement, it is important that physicians, while submitting claims, do not forget to sign in wherever required so as to avoid being embarrassed with notices for resubmission.<\/li>\n<li><strong>Consistent assignment to the same level of service:<\/strong> It is inviting suspicion as your payers might term \u2018consistent assignment to the same level of service\u2019 as duplication, and return the subsequent claims as invalid. Further, they may ask for explanation on the efficacy of repeating the same service again. To avoid, such undesirable scenario, a higher order coding is advised for subsequent services.<\/li>\n<li><strong>Billing as a consult rather than an office visit:<\/strong> Although, at the outset, they might seem similar, consulting fee is deemed higher than regular office visit. Misrepresenting your manner of service will have a direct bearing on the outcome of reimbursement, and upon being found out by the payers\u2019 audit checks, you may be called upon to furnish a suitable explanation. Therefore, code for the correct context to avoid being exposed during audits.<\/li>\n<li><strong>Use of invalid codes (for example, codes taken from an outdated resource):<\/strong> The prime reason behind most billing blunders is the physicians\u2019 perception that billing and coding standards are permanent; whereas there have been as many reforms as one can think of in billing and coding. Therefore, they need to keep themselves abreast of frequent changes in coding.<\/li>\n<li><strong>Unbundling of procedure codes:<\/strong> Physicians, albeit unknowingly, or their billers, tend to fragment their procedure into parts, and assign codes accordingly. Whereas insurance companies, which feel such fragmentation tends to disproportionately increase claims, are known to have sent notices requesting physicians to not to unbundle their services.<\/li>\n<li><strong>Misinterpreted abbreviations:<\/strong> Abbreviations, meant for reducing description, need to be used suitably to avoid a billing lapse.<\/li>\n<li><strong>Failure to list chief complaint:<\/strong> Physicians, sometimes, looking for incidental charges may forget to state the chief medical complaint itself. Such mistake can render your claim as \u2018insufficiently substantiated,\u2019 and returned with audit remarks.<\/li>\n<li><strong>Billing as a separate professional fee for those services included in a global fee:<\/strong> Physicians \u2013 not knowing the extent of coverage that their patients insurance schemes allow \u2013 sometimes, tend to club additional professional services while billing for certain cases that carry global-fee tag. As the insurance companies are obliged to reimburse only the global fees, physicians might not get the reimbursement for what they claim to be additional services.<\/li>\n<li><strong>Use of an inappropriate modifier or no modifier for accurate payment of a claim:<\/strong> Modifiers \u2013 which play an important role in suitably modifying codes for incidental medical services \u2013 need to be used with discretion. Rampant and indiscriminate use of modifiers can be termed as \u2018unacceptable practice\u2019 and be eligible for \u2018audit notes\u2019 from your insurance carriers.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p style=\"text-align: justify;\">Given the pattern of billing blunders, and their consequences on claims realizations, individual physicians, clinics, hospitals, and multispecialty groups should look at devising a preventive program that can mitigate the recurrence of billing blunders in the larger interest of their sustainable practice and growth. Consequently, the preventive program entails<\/p>\n<ul style=\"text-align: justify;\">\n<li style=\"list-style-type: none;\">\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li>Educating themselves and their staff on proper coding<\/li>\n<li>Continuous upgrades in terms of latest updates in coding<\/li>\n<li>Continuously assessing the coding procedures to identify the most common errors and reduce them<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p style=\"text-align: justify;\">Whereas these positive measures can be practiced internally, yet, physicians \u2013 who tend to be wary of exhaustive billing management practices \u2013 can fall back on proven outsourced solutions to meaningfully streamline their<a href=\"https:\/\/www.medicalbillersandcoders.com\/medical-billing-services.aspx\"><strong> medical billing processes<\/strong><\/a> for optimized reimbursements.<\/p>\n<p style=\"text-align: justify;\"><a href=\"https:\/\/www.medicalbillersandcoders.com\/\">Medicalbillersandcoders.com<\/a>, who a have long-standing reputation of being the largest medical billing consortium with a substantial presence across all states of the US, should be of immense help in devising a comprehensive program that can effectively quell billing blunders.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>The growing incidence of delays, denials, audits, and resubmission of physicians\u2019 medical bill claims is reason enough to have a relook at the way physicians\u2019 services are billed and coded. In a medical insurance environment, characterized by stringent billing and coding compliance, inherent billing and coding errors are easy to catch. Further, lack of knowledge [&hellip;]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[65],"tags":[112,63,15,113],"class_list":["post-353","post","type-post","status-publish","format-standard","hentry","category-practice-management","tag-common-billing-blunders","tag-medical-bill-reimbursements","tag-medical-billing","tag-medical-billing-blunders"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.8 (Yoast SEO v27.8) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Decoding Common Billing Blunders &amp; Devising Ways To Quell Them - Medical Billing and RCM Blogs<\/title>\n<meta name=\"description\" content=\"Learn about Decoding Common Billing Blunders &amp; Devising Ways To Quell Them in our latest blog post. 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