Steer Clear These Medical Billing Mistakes for a Successful Healthcare Revenue Cycle

Medical billing is the backbone of healthcare revenue cycle management. But it can be a painful process for some providers due to the interaction required with an array of healthcare stakeholders, challenges involved in efficiently and accurately billing patients and payers for the services being performed etc. Effective medical billing is essential for efficient revenue cycle management. This will ensure that healthcare providers can focus on what matters the most: giving quality care to their patients.

Below are some of the most common mistakes committed by practices and clinics, preventing them from billing properly and increasing the duration of their accounts receivables:

Incorrect Patient Information: Patient information is the foundation upon which claims can be submitted and paid. Collecting incorrect information such as incorrect date of birth, misspelled name etc. may result in claims denial. It’s important to double-check the accuracy of the information that is collected during the initial interaction with the patient.

Not checking patient’s insurance coverage: Apart from a patient’s demographic information, it is also important to verify health insurance status and coverage. As per a survey, the eligibility issue is the top most reason (about 80%) for claim rejections. The survey stated that right questions related to eligibility were not asked to the patients and the insurance companies, causing an increase in denials and rejections. So, it’s important to evaluate a patient’s insurance plan and eligibility each time an appointment is scheduled. A checklist with questions may be given to the front-desk to serve as a guideline while evaluating eligibility such as:

  • Is the patient registration information correct or is there any change from the last visit?
  • Does the patient have valid insurance that can be accepted by your practice?
  • Is there any additional insurance with the patient?
  • How many visits are allowed for the patient?
  • What is the patient’s payment responsibility?

Inaccurate coding: The ICD-10 implementation went smoother than expected. But coding inaccuracies are still a significant challenge for many healthcare providers. The American Health Information Management Association (AHIMA) has identified several recurring mistakes in coding such as incorrectly applying the seventh characters for trauma and fracture codes, misidentifying a respiratory failure, improperly using procedure codes that drive a diagnostic related group, mistaking the use of guidance tools and insufficiently documenting devices, components, and grafting materials.

These mistakes or incorrect coding of a medical service is likely to lead in claims denials and a significant loss of income and productivity. So, the healthcare organizations should regularly train their clinical staff on ICD-10 coding updates (though it will take some time for the staff to become proficient in the new coding practices) and encourage their front-end staff to communicate with clinicians if there are documentation issues.

Not informing patients about their financial responsibility: With the increase in high-deductible insurance plans, patients have to take a greater financial burden in the payment of medical bills. Thus putting an extra financial strain on hospitals and practices to put more resources to collect payments and bring in owed revenue.

So, to boost patient revenue, healthcare organizations should implement financial policies that include estimating costs of services, informing patients about their financial responsibility and collecting some of the balance during their appointment.

Billing in-house when your staff is overworked: If the workload with the administrative staff is high, it may result in less efficiency and more billing mistakes. Keeping up with the regular coding updates and revisions in billing practices may add extra work load on your staff.

One option to avoid these medical billing mistakes could be outsourcing billing services. Outsourcing not only increases claims payments, decreases labor costs as well as resources allocated towards in-house billing but also increases overall revenue for hospitals, practices and clinics.