OVERVIEW OF THE COMMON MEDICAL BILLING ERRORS:
The complex medical billing and coding process may vary depending on the patient, insurer, and standard methods. Claim denials are unavoidable even by the most meticulous and focused financial service departments. Knowing and understanding the most frequently made mistakes helps the organization to steer clear of common medical billing mistakes.
What Are the Most Common Medical Billing Mistakes?
Missing patient information
The most common medical billing mistakes happen due to missing information in the submitted claims. Common medical billing errors occur by incomplete details like accident date, patients' complete name, the date which the patient availed the emergency service etc., Must check all the fields precisely before submitting the claim, as it is of paramount importance to avoid claim denial. It is easier to handle critical information by using a portal to update and store patient details.
Claim not submitted within the time window
Missing out the time window while submitting claims is another most common mistake in medical billing. The first day of the patient's service is considered the starting date while filling a claim form. The claim must be submitted within the time window provided by the medical claim provider.
If a proper claim fails to be submitted within the time window, there is a high chance for denial. Claim filing is done within the deadline to ensure the submitted claims get processed without any delay.
Wrong Patient Information
Another common billing mistake that results in claim denials is wrong patient information. Many times, incorrect spelling of patient's name, wrong numbers in the date of birth field, mistakes while filling in the sex of the patient altogether contribute to a higher number of claim denials. Also, the insurance policy number, the insurance payer's name, and the patient's relationship to the insured must be correct.
Though time-consuming, scrutiny of these fields and essential patient information and insurance details are vital. By using sophisticated software for medical billing and coding helps avoid mistakes. Double-checking all the information entered reduces the number of denied claims.
Issues related to coding
Using outdated coding or incorrect code by the biller or coder can also result in claim denials. Upcoding happens when the patient's diagnosis requires an upgrade owing to a far more critical condition. In this case, the patient needs more expensive treatment. Under coding results when a less expensive service is missing during the process of medical coding.
When documentation is deficient owing to a missing vital document, mistakes occur. The system bills only the cases that are documented. The absence of any document related to a service provided will automatically be considered a non-performed service by the insurance provider.
Duplicate Billing
At times the claim is resubmitted and fails to be removed from the account of the patient. Once all the process is over, duplicate billing gets indicated. At times, the patient is billed twice for availing of specific services or certain procedures.
The medical staff sometimes fail to verify if the patient has already paid for the service provided. In such cases, it appears that the patient has received several treatments on a single day, which is incorrect. Owing to such human errors, duplicate billing is created which results in claim denials.
Patient Eligibility
It is essential to check the patient's eligibility for various services covered and not covered. It is easy to update the insurance information regularly. Whenever the patient avails of a service, it is necessary to check the patient's eligibility to ensure that the patient's plan covers the service provided.
To improve the quality of patient data, it is imperative to regularly update the policies and train the staff in the billing team. Obtaining a prior certification before submitting the claim is vital. To minimize errors, the organization can utilize software’s that are readily available for medical coding and billing.