Patient billing is how medical practices are able to stay open. Billing errors can lead to denied claims, leading to a loss in revenue for the practice. If this becomes a common occurrence, an establishment may go bankrupt from being unable to pay wages from lack of revenue. Most independent clinics say that about 15-25% of claims are inaccurately submitted. Let’s see what the largest contributing factors to this inaccuracy are.
1. Billing the Wrong Payer
Ensuring correct payer information is key to a successful billing process. Practices could have thousands of patients in their system, which means a slight typo or confusion can lead to a completely lost claim. Mistakes can also happen by billing the wrong payer on a coverage plan or by confusing which plan a patient is on under their insurance provider.
2. Omitting Details on Claims
Medical billing claims must be coded to the highest level with a very specific code. One slip-up can lead to a denial. It takes a very skilled team of medical coders to ensure that no details are missing on a claim.
3. Upcoding
Upcoding, or using a higher-level code than justified, can lead to real legal issues, like audits. This is often done to receive a larger reimbursement than is necessarily justified.
4. Failing to Verify Patient Insurance
Insurance information can change at any time. Without consistent and diligent updating, a practice may run into a scenario where the service is not covered. Make sure that the services you are providing are still covered by the patient’s insurance. This can be prevented by having a strict system in place for verifying insurance coverage at each visit.
5. Missed Filing Deadlines
The tricky part about medical claim deadlines is their ever-changing nature. The Affordable Care Act recently reduced the period for claim submissions for Medicare providers from 27 to 12 months. This makes it much harder for in-house medical coders to keep up with large quantities of claims and submit them for insurance. Insurance will deny a late claim submission.
6. Bundling Medical Procedures
Bundling medical procedures can quickly become a problem if you are not a very skilled coder who knows all the by-laws and specifications for coding. For example, a coder may choose to bundle several procedure codes if they are related to reducing the number of redundant claims sent out. Likewise, they may choose to unbundle services that just happen to be on the same day but are unrelated.
7. Incorrect Modifiers
The most common medical billing error is the misuse of modifiers. Medical coders should be trained and retrained regularly to stay up to date on medical coding protocol. Using the wrong modifier can lead to claim denials.
Our expert team with decades of experience can help you reduce your medical billing mistakes and maximize your profit. Contact us at (916) 382-0653 to learn about our services.
