Medical offices are often fast-paced environments where common, even simple, mistakes can and do occur. Unfortunately, that’s going to be challenging to achieve if your billing efforts aren’t optimized for success. Below are the Top 5 Medical Billing Errors you can avoid.
1: The Patient’s Insurance is Inactive or Terminated
We find that this is the most common reason a doctor’s claim will allow for rejection. When performing treating a patient, you always want to check their availability at the time of service. Some of the most common denials include services not authorized or covered by plan, insurance that has been terminated or no longer eligible, and maximum benefits been met. With UnisLink’s integrated eligibility checking software, we allow you to check a patient’s eligibility at any time.
2. Not Using A System for Filing Claims in A Timely Manner
Without an effective plan to keep billing running on time, it can get pushed aside. Filing claims on schedule remains essential. Most payers maintain a timely filing limit, and some are as little as 30 days from the date of service. Miss that deadline and the claim may be denied for timely filing.
3. Incorrect Coding Issues
If you are using an outdated codebook or your coder or your biller enters the wrong code, your claim could be denied. The use of outdated coding books either CPT (Current Procedural Terminology), ICD-10 (International Classification of Diseases) or (Healthcare Common Procedure Coding System) HCPCS or super bills will result in loss of revenue.
Coders unequivocally play a key role in denials avoidance, and they are best suited to use a proactive approach. With UnisLink’s certified coders, we ensure correct and accurate coding.
4. Incomplete or Incorrect Patient Information
Another very common reason for denials is from errors and inaccuracy. This often happens during the patient registration process. A single empty or unchecked box on a claim can be all it takes to cause a denial. Even the most fundamental fields like gender, date of birth, and time of the accident or medical emergency are commonly left blank. To ensure payment is made the first time, have the front office staff assist by double-checking these details.
5. Upcoding or Unbundling
Purposely inflating the level of service or procedure performed to receive a higher reimbursement rate or charging for a different service than what was provided is called upcoding. Billing for procedures separately that are generally billed as a single charge is called unbundling. Unfortunately, there are also times when this form of incorrect medical billing occurs accidentally, not deliberately. This is common for anyone who is inexperienced with medical billing and coding, when office staff is overwhelmed with the number of claims they’re handling.
Please contact us for a free advisory consultation with more information on this topic.