Medical billing is a stressful process for healthcare providers. Accuracy at every step is essential to ensure that the reimbursement occurs on time and also helps to maintain a cordial relationship with patients and insurance companies. But, medical billing has errors, and it can hurt the reputation of a healthcare practice. This blog post brings to light five common billing errors along with actionable solutions to avoid such mistakes so healthcare providers can streamline the process of billing and focus more on patient care.
1. Inaccurate Patient Information
- Challenge: The most common billing mistake is the entering of incorrect or incomplete patient information. This includes misspelling of names, dates of birth, incorrect insurance information, or simply out-of-date contact information. This usually leads to claims denial or delay.
- Solution: The procedure is simple but requires diligence. Verify all patient information before submitting any claim. Educate your administrative personnel to double-check details when patients are coming in for appointments, especially the insurance details. You can also have an electronic system that performs checks and validations automatically reducing human error.
- Tip: A confirmation call before a scheduled appointment or an online form ensures that patient data is current and accurate, avoiding billing errors from the onset.
2. Failure to Obtain Prior Authorization
- Challenge: Prior authorization by many insurance companies is required for certain procedures, medications, or treatments. Lack of them can lead to denial or a lag in the claim, and ultimately, a delay burdened upon the healthcare provider.
- Solution: Establish procedures for obtaining pre-authorizations with clear steps in place. Depute a designated person or even a department, who is responsible for this particular task and are aware of each insurance company’s requirements. It is also wise to remind a follow-up step and track every approval to prevent missing any action.
- Tip: Have an EHR system that ties into insurance databases. This could make it easier to order and track prior authorizations.
3. Duplicate Billing
- Challenge: Duplicate billing occurs when a healthcare provider accidentally submits the same claim more than once. This can be caused by system malfunctions, human mistakes, or misinterpretation of the payment status. Duplicate claims often lead to rejections or overpayments, causing long-term financial problems.
- Solution: Implement robust claim tracking and monitoring systems that show claims with the same dates of service and codes. Review regularly the status of claims to find potential duplicates before submission. Develop a specific process for the management of payments to ensure it is recorded appropriately.
- Tip: Most billing software systems have a way to spot and prevent duplicate billing by marking repetitive claims. This, of course, saves a considerable amount of time and trouble in the long run.
4. Coding Mistakes and Misunderstandings
- Challenge: Incorrect coding is the biggest problem in medical billing. Inappropriate ICD-10, CPT, or HCPCS codes cause denied claims or delayed payments. It may be because of a misinterpreted diagnosis or procedure or simply because the wrong code was chosen.
- Solution: Keep your staff well-trained and updated on new codes. An expert coding coder would help to prevent this error from happening as the codes will be cross-checked before submitting them. Using billing software with the in-built validation feature of the codes would prevent this type of error.
- Tip: Train your billing staff and utilize coding tools to include the ICD-10 and CPT code books for better situational awareness.
5. Failure to Follow Up on Denied Claims
- Challenge: One common mistake providers in the healthcare industry do is ignore those denied or rejected claims, feeling they are hopeless or unrecoverable. Sometimes this results in lost revenue due to the practice of failing to catch reimbursable money that belongs to them.
- Solution: Implement a process of tracking denied claims and acting within a timely fashion. Designate a staff person to review the denied claim and resolve it by contacting the insurance company or by resubmitting the claim with corrections in place. Work to correct the cause of denial by error, omission, or coding errors.
- Tip: Keep a claims tracker to identify whether any of those are pending or denied; your team, then, can follow those and prevent that lost revenue as well.
Ensuring Financial Health and Operational Efficiency Through Effective Billing Practices
Medical billing mistakes can cause considerable financial and operational burdens for healthcare providers. However, with some straightforward and effective strategies, healthcare practices can avoid such common pitfalls. Patient information accuracy, proper coding, obtaining prior authorizations, avoidance of duplicate billing, and tracking denied claims should constitute integral processes to make a billing process easier. Improvement in medical billing practice leads to efficient workflow as well as good patient satisfaction. With these errors in billing not made, a practice can receive timely reimbursements and focus on excellent care delivery to patients.
If you want to simplify complicated billing processes prone to errors, consider outsourcing these services to professionals. Help them streamline this process so that you can redirect your focus to who matters most to your patients.