Some groups have found in their research that three out of every 4 medical bills could contain an error. Medical billing errors are costing individuals, insurance companies, and healthcare facilities a ton every year. Today’s healthcare system can be a mire of bureaucracy and red tape that tends to facilitate this high rate of error. A good eye and proper training is needed to combat the negative trend and provide patients with high quality service.
Errors can cause payments to be delayed or denied, which could lead to fines or loss of revenue. To maximize efficiency, it’s important to work with experts in payer contracting whilst also being able to immediately recognize some of the most common billing errors made, allowing them to be fixed before submission.
Today, we’ll look at some of the most common medical billing errors so that you can be aware of what might be costing you extra money and time.
Missing, Incomplete, Vague, or Wrong Information
Something as simple as missing contact information can cause a rejection of your claim. It can be difficult to be thorough when processing many claims every day but be sure that every field is populated with the correct information before sending your claim.
Adequate information to justify diagnoses and procedures is important for insurance providers to accept a claim. If a provider feels that enough information has not been provided, then they can reject or deny the claim. Make sure you provide the right information so that the correct code can be applied.
Coding errors are the most prominent error made. Codes are being updated regularly and it requires diligence to stay on top of them. A good source of information to keep you well-informed can be found at Best Medical Billing Coding.
Upcoding and Undercoding
One of the most frequent billing errors is upcoding, which is the process of billing for a more serious diagnosis that results in an inflated bill for the payer. Often done intentionally, upcoding is considered fraud and is illegal; for example, charging for a name brand medication when a generic was actually administered. Accidental upcoding occurs on a frequent basis as well, usually as a result of not understanding the information given by a physician or from unfamiliarity with the proper codes.
Undercoding occurs when lesser charges are billed relative to the services provided. Similar to upcoding, undercoding can happen due to incorrect code entry or misunderstanding physician orders. Good communication and record keeping can alleviate the rate at which errors are made.
Unbundling of Services
When more than one procedure is part of a package code but billed separately, it can lead to much higher costs to the payer. Much like upcoding or undercoding, this can be a result of a lack of experience, the skill of the biller or bad information from the caregiver. To avoid unbundling services, one must be proactive to keep up with the ever changing procedures.
Most of the common errors in medical billing can be avoided with a good eye, attention to detail, and a good knowledge of up-to-date codes and procedures. With the costs of healthcare rising quickly, it’s vital to make as few errors as possible to keep costs low for the payer – and to be correctly reimbursed for services rendered.
