Medical Billing Nightmares - Common Mistakes in Medical Billing

Common Mistakes in Medical Billing

Errors in the billing process can significantly reduce the profitability of a medical practice and should be avoided. By having a clear understanding of the entire coding and billing process and developing protocols for practice management, the medical office can run smoothly, efficiently and ensure maximum profitability.

A well-run and profitable medical practice always has a written procedures manual for all phases of operation. Most importantly, procedures in the reimbursement process: billing and coding, insurance issues and patient accounts should be kept in easy reach. Clear guidelines on the processes to manage accurate entry of all services provided and generation of correct insurance claims and patient bills lets all staff members know the accepted protocols and provides an easy to access reference when questions arise.

Errors in the reimbursement process fall into two categories. The first kind of error is technical: errors in generating and submitting claims, and then in processing payments correctly. Technical errors include missing or inaccurate data on claim forms. The second kind of error is in customer service: mistakes in managing patients accounts and treating patients in a way that is disturbing or disrespectful. Both of these mistakes can have grave consequences in the profitability and success of a medical practice.

In addition to clearly spelling out the steps of all phases of the billing cycle, office procedures manuals should address common mistakes in the reimbursement process. Some of the most common problems are outlined below.

1.) Technical errors

Mistakes in the technical aspects billing process cost money for a practice because claims are needlessly denied or delayed. These included claims and coding errors and insurance errors. Correcting the problems requires time spent researching the problem, making corrections, and generating a duplicate claim form. Unfortunately, a problem in many medical offices is follow up on unpaid claims. Many times, poor follow up leads to unnecessary write-offs and lost revenue. Careful attention to procedures can rectify most of these kinds of errors.

2.) Claims and Coding errors

Illegible claims
Misalignment of printed claims
Coding errors
Unbundling
Upcoding
Services provided without a medical necessary
Incorrect/outdated diagnosis or procedure codes
Insurance errors

3.) Failure to obtain pre-authorization of referrals

Submission of claims to wrong insurance company or outdated address
Failure to obtain insurance information for responsible party when a dependent or spouse is being treated
Calculating co-insurance based on incorrect fee schedule
Miscalculation of deductible, copays or so-insurance
Other common mistakes in medical office reimbursement involve billing and financial policies. It’s a well know fact that the longer a bill goes unpaid, the less chance of recovering payments. That means that timely and efficient handling of accounts receivable is critical. Some common errors in this area are listed here.

4.) Billing errors

Lack of consistent billing cycle
Statements patients can’t understand
Credits not posted to patient accounts
Overcharging
Duplicate billing
Charges for services not provided
Billing for services that are not medically necessary
Exceeding time limit for filing claims
Incorrect or inappropriate Finance charges
Poor Financial Policies

5.) Rebilling charged-off balances

Denial of necessary care for financial reasons
Intimidating or threatening collection efforts
Non-compliance with insurance contracts
Verbal payment agreements
Inconsistent collection practices
Reluctance or refusal to explain billing policies and patient statements

Errors occur. It's inevitable. BUT, catch them! As a medical biller, it is your job! Pointing out errors, owning up to errors, and FIXING the errors will help you KEEP clients. The oposite practices will cause you to loose clients!
For more information about medical billing nightmares, visit www.MedicalBillingFoundation.com