One of the most common problems patients encounter with healthcare is getting much higher than expected bills because of mistakes. They could amount to a significant sum, and you may face legal consequences if you do not pay them.
Unfortunately, mistakes in medical billing and coding are pretty standard. This may result in a denial of your claim or an increase in your out-of-pocket expenses, and without the proper medical office software, it might worsen things.
In other words, medical billing has become one of the challenging processes that modern healthcare companies have to solve. Billing mistakes may result in severe financial losses and claim rejections. How can you avoid making these mistakes and speed up the payment process? Keep reading to find out!
According to analysis, mistakes in medical billing are responsible for billions of dollars in annual billings. Research shows that 80 percent of medical bills include errors, and over 50 percent of Medicare claims have errors.
In addition to causing insurers to lose millions of dollars, it also makes patients unhappy and slows down the reimbursement process for their medical expenses.
Therefore, what exactly are some of the most common causes why mistakes occur in medical billing? To answer your question, this article has you covered. Keep reading to find out the top 10 causes. Let’s get started!
Inaccurate patient information
If wrong information about a patient is put on a medical bill, it could lead to fines and possible legal action.
The patient’s health could be at risk if the wrong diagnosis and information are sent in. Even if there is an issue with the modifier, the location of the conducted process may be altered.
In addition, extra CPT codes may sometimes result in an unexpectedly high cost for the patient, which can be frustrating for everyone involved.
It is essential to be accurate when drafting and submitting bills. Therefore, wherever possible, use accurate patient information. If you find any errors, please do not be hesitant to bring them to the attention of your accountants or the billing staff at the hospital.
Duplicate medical billing
Medical billing is one of the most critical and time-consuming business processes. Most medical billing mistakes are caused by duplicate billing, often due to an office employee failing to ascertain whether the patient has previously paid for the treatment.
This is known as duplicate billing, when a practice bills a patient more than once for the same test, assessment, treatment, or operation. It might give a false feeling of security and trust in your practice if there is duplicate billing.
However, this may cause more administrative work for both your team and the payer since it may seem that the patient got many treatments on the same day when only one was rendered.
In addition, if prospective patients discover that they got improper treatment or documentation from the start, this might backfire and jeopardize your firm.
Incorrect medical coding
Many things can go wrong when billing patients, but one of the most common is wrong medical coding.
The person in charge of billing can put in the wrong number of digits for a code that describes a symptom, a diagnosis, or a treatment. This might happen either way.
However, the code may also be updated, and there may also be a possibility that it may be changed or removed from the system.
This might confuse the difference between what was billed and what was completed. This might have repercussions for the patient and the insurer, who might end up dissatisfied with the results.
It is essential to use the right coding system when you are billing for services. You should also check to ensure no inconsistencies in any other parts of your statement.
Delayed or incorrect payment
When it comes to billing, there are several opportunities for error. Some of the most common medical billing mistakes are wrong dates of service, leaving out required charges, and not writing down costs.
To avoid these problems, you should always keep a record of what your doctor’s office does for you. This can help you determine the medical billing codes used to pay for your care.
Additionally, ensure that all services are invoiced in the same currency. This will guarantee that all charges are accurately recorded on your bill, and you should also double-check all invoices to verify that they correspond to the services rendered.
Suppose you make a mistake with your medical billing. In that case, you could waste a lot of money on treatments that aren’t necessary and get fined by your insurance company, so it’s essential to be ready and focused.
Unbundling
Some hospital medical billing codes are intended for use with a collection of treatments that are often done together. Unbundling refers to when these services are billed under different codes.
But it’s important to note that unbundling is against the law because it can increase the practice’s or center’s income, even if it was an honest mistake.
This might result in an overpayment, underpayment, or no payment, which can cause financial hardship for patients and doctors.
When it comes to medical billing mistakes, there are a few things that everyone should keep in mind:
- Always get a breakdown of spending per supplier.
- Be on the lookout for red signals that suggest everything is not as it appears.
- Be prepared to accept your errors and take corrective action.
Doing so may prevent becoming one of the many patients who are ultimately dissatisfied with their treatment.
Failure to include a billing address on the application
If a patient’s information, such as billing address, is erroneously or insufficiently coded, it may affect a claim.
Inaccurate patient data may result in rejections, non-payment, and investigations. It is crucial to confirm insurance coverage accurately to get all the details straight.
To avoid these issues, ensure your application includes a billing address. If you don’t, your health insurance could make mistakes when processing your bills and even fine you.
In addition, ensure that your insurance coverage information is correct. If you are unaware of the specific benefits your health insurance offers, get a list of covered treatments and contact information.
Failure to verify insurance
One of the most common mistakes made in medical billing is not validating the patient’s insurance. This mistake could cost the healthcare provider millions of dollars in lost income, missed chances to get paid back, and even legal action.
When it comes to denied claims, insurance problems are by far the most common cause. Generally, failure to verify is caused by an excessive dependence on routine.
However, companies can avoid making these errors if they take the time to check insurance claims and ensure that all medical expenses have been covered.
In addition, they are omitting information about insurance coverage from a claim form. This might result in misunderstandings about who is liable for paying for expenses, which may lead to claims being refused or extra costs being incurred.
You can ensure that there are no problems with the patient’s insurance policy that might lead to refused claims if you make it a point to check the patient’s insurance at every appointment.
Invalid diagnosis codes or procedure codes
Invalid/missing principal diagnosis indicates that the claim’s first listed diagnostic cannot be used as the claim’s first listed or principal diagnosis. It is essential to consult your coding guides before implementing this code.
Diagnostic and treatment codes are periodically updated. Consequently, one of the present rules will likely be modified or removed. However, if this happens and you dispute the incorrect code, the billing software or clearing house will instantly reject your claim.
The easiest method to avoid this error is to ensure that your coding manuals are updated and that your frequently used codes are examined annually to see if they have changed.
Filing a claim without providing proper documentation
When a patient sends in a claim, they must include all the necessary paperwork to back up their claims.
However, there are many instances in which patients do not take the time to give this data or may offer the wrong documentation. Either way, this is unacceptable and may impact how billing processes are carried out.
In addition, to prevent being in this situation, it is essential to double-check your documentation and ensure that it is up-to-date continually.
Falsifying information on the claim form
In medical billing, falsifying information on patient forms may lead to significant medical record mistakes and result in monetary fines for patients.
For instance, if you provide a name different than your actual name on the claim form, your insurance company will likely not pay you. They may attempt to identify you based on the information included in your record.
Nevertheless, if you are responsible for filling out a form in your hospital’s medical billing system, take the necessary precautions to ensure that your information is valid. This means making sure the information is correct by checking it with other sources, such as insurance company data or Medicare papers.
Conclusion
Medical billing and coding mistakes are common and may result in considerable patient financial losses. To avoid these errors, it is essential to comprehend the fundamentals of this procedure.
On the other hand, it is essential to be aware of the typical medical billing and coding errors that might occur; this article identifies the top 10 sources of these errors.
In addition, the best strategies to avoid these mistakes are to be familiar with the coding systems used in your country, to get assistance with billing and coding when necessary, and to maintain a record of all medical costs paid
However, to ensure that you and your loved ones get the highest standard of treatment possible, you must avoid making any mistakes in your medical billing and coding. Doing so may preserve your health and prevent unnecessary, costly medical expenses. Thanks for reading!
