5 Ways to Avoid Common Medical Billing Mistakes

Touseef Riaz

February 22, 2021


5 Ways to Avoid Common Medical Billing Mistakes

If you run a medical practice, you know that providing quality healthcare to your patients can be complicated because of many reasons. One of these reasons is common medical billing mistakes. Recently, ABC News revealed the research findings of a group of statutory auditors who were engaged by insurance companies in order to review patient bills. It is worth noting that the auditors found that an astounding 90% of these bills had errors and mistakes that usually cause patients unnecessary financial hardship, inconvenience, and stress.  

Did you know that an article in the Wall Street Journal states that 30 percent to 80 percent of medical bills have errors? And you should know and understand that high rates of medical claim denials as well as rejection can impact your medical practice’s revenue and profit considerably? And you don’t want that.  

There is no doubt that medical billing and coding mistakes have become increasingly common. Note that these common medical billing mistakes can occur because of a lack of knowledge of changes in insurance coverage or the changing laws and regulations. Also, note that these mistakes can also happen because of human error and miscommunication.

The unfortunate thing is that medical billing mistakes are rampant in the industry, especially in the substance abuse, mental health, and behavioral health services. As solving these issues and problems can usually take long enough to cause some serious disruptions in patient care, as a provider, you have to do whatever you can to avoid billing errors and mistakes.

Here are five ways you can avoid making some common medical billing mistakes and errors.

1.     Double-Check Patient Information

Keep in mind that healthcare is essentially a customer service. So, like any other customer service, sometimes, your customers can cause quite a few problems. For example, you may know that some customers can be quite uncooperative and difficult. On the other hand, some customers can be ignorant.

This is why when you are submitting a medical claim to the relevant insurance company for the medical services that you have rendered, it is important to enter every detail of your patient’s information accurately and correctly. You may know that even if a single digit is off from an individual’s insurance ID number or social security number, the insurance company will deny your claim.

Although it might take an extra few minutes, reviewing what you have entered into your system will likely save you a big headache, especially in the long run. Keep in mind that even a small mistake, like a patient’s name, birth date, and gender, can lead to the denial of a medical claim.  

Also, note that if the patient isn’t the policyholder, you have to check the relationship with the policyholder in order to confirm all the details and information for accuracy. It is no secret that patient information is a very crucial part of most medical billing practices. This is why you should implement an infrastructure to ensure that all information you receive from your patients is timely verified multiple times before you proceed with billing.

2.     Check Insurance Eligibility

Make it a practice to verify insurance beforehand. Did you know that practice management software will help you do this? The software will access all the information online from the insurance company immediately. As a result, you will not have to force your employees to call the insurance provider and wait for the answer.  

Note that whether the patient is a new or repeat client, you have to verify their insurance and also obtain a physical copy of your patient’s insurance card. It is important to check the effective date as well as the coverage period first.

After that, verify any copayments or deductibles due at the time of service. And if you have any questions regarding the validity of the insurance, you should call the company directly in order to confirm before submitting the claim.

At times, medical practices allow their patients to go through without any verification. They do this to lower waiting times for other patients. However, this is not advisable. It is best to call a patient’s insurance provider before providing the treatment.

3.     Make the Most of Electronic Medical Records

You probably know that an electronic medical record (EMR) is a convenient electronic version of a paper chart containing a patient’s complete medical history from one practice. Doctors and other healthcare providers use EMR for diagnosis and treatment of patient issues.

It is worth noting that an EMR system helps achieve the following:

  • Lower physical storage space
  • Monitor and enhance care quality
  • Track changes in medical data

Did you know that using an EMR system is an excellent way to avoid common medical billing mistakes and errors? A variation of EMR is known as the electronic health record (EHR). Healthcare providers can easily share it.

There is no doubt that an EMR has a lot more benefits compared to paper records. This is because it allows you to:

  • Easily track patient data as well as reference your patients’ medical history
  • Improve and enhance the overall quality of patient care
  • Identify patients that are due for preventative measures or screenings

It is worth noting that standardized EMR systems are more effective and efficient and tend to make clinical coding simpler and easier. You may know that errors and mistakes on medical bills usually occur because of handwritten notes and other instructions that are not clear. Electronic medical records are convenient as they save time. They are also more efficient and much easier to keep confidential.

Did you know that the use of electronic records can lower the number of duplicate tests? And with these electronic records, a physician or doctor treating a patient will also have insights into other physicians’ treatments. So, for example, if a doctor has already ordered a test, both doctors can share the results and provide better healthcare to that patient while minimizing medical billing mistakes.

4.     Maintain a Record of Submitted Claims

It is worth noting that another common billing mistake involves submitting duplicate claims. Note that if your medical office inadvertently submits duplicate claims, then the insurer will deny the second claim.

There is no doubt that denied claims can cause confusion. This is especially true if your medical office doesn’t realize two medical claims were submitted. You should use claim type indicators or reference past medical claim numbers to avoid sending the same data. It is best to invest in an excellent records management system that tracks all claim submissions.  

If you maintain and regularly update your records, your staff will be able to verify claim submissions and also eliminate any duplicate claims. And by adequately coding the medical claim with the relevant modifiers for the treatment or disease, your medical office can easily lower the number of suspected duplicate denials.

5.     Stay Updated on Coding Rules

There is no doubt that medical billing codes are frequently changing. This is because of the many modifications and changes in healthcare regulations and laws, newly discovered illnesses and diseases, and newfound treatments. You should know that change is constant and medical codes are often updated, changed, or replaced.

And because of all the new medical codes which have been introduced, note that medical claim denials have certainly increased for many medical practices in the country. So, you should keep up to date with all new billing codes as well as procedures as soon as they arise. As coding procedures are regularly changing, even many seasoned medical staff members can make mistakes and errors when relying on their memory.  

Note that this will lead to many common medical billing mistakes and may cost you a considerable portion of your revenue. So, medical coders in your office should make all efforts to stay up to date on the latest medical codes as well as any coding changes. It is also important to invest in constant training and development for your staff so that they can be up-to-date with the most recent insurance codes.

Final Thoughts

You likely know that medical billing is certainly not a walk in the park. This is because it’s a complex process that requires expert knowledge and experience of the ever-changing laws and regulations. Keep in mind that proper training and more attention and care by billing staff are some of the most effective ways to reduce medical billing mistakes and errors.  

You should also take the time to implement strict quality-control programs and policies. This will help ensure that your staff understands all the steps they have to take to keep your medical practice’s billing and coding practices and procedures as mistake-free as possible. While taking the above steps might not prevent all medical billing mistakes and errors, you will avoid many. And it will also lead to a more responsible practice and positive relationships with your patients. Finding a detail-oriented, reliable, and experienced medical biller can be difficult for many practices. However, UControlBilling can certainly help you with this problem. UControlBilling knows that your medical billing process can be time-consuming and stressful. The team at UControlBilling can relieve this burden by providing you with high-quality revenue cycle management services – from your front desk to your back office. UControlBilling can help you streamline and improve any part of the revenue cycle.

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