Common medical billing errors that affect your income

Billing errors result in nearly 30% loss of revenue. These errors are a common cause of refusal claims by insurance companies [payers in the United States]. Medical bills are more than just documents; this is a means of generating income. Since the maximum percentage of doctor's income comes from the payer, there should be no common mistakes in the settlement process.

1. Incomplete patient information

When testing a company's vulnerabilities, it's best to start with the basics. When entering the name, date of birth, and gender of the patient, it is necessary to check for stupid mistakes because the error detected by the payer will result in rejection.

2. Lack of patient validation

The lack of a thorough patient validation process reveals the potential risk of lost income. Complete verification should include verifying the patient's policy number, insurance policy number and coverage, welfare allowance limit, inspection program authorization, etc.

3. Service date and timely filing

Indeed, things that point to the right service date are often missed and become the reason for refusal to reimburse. Not only that, if the doctor wants to pay, he or she needs to file a claim within a certain period of time from the date of service. Missing the deadline results in delayed reimbursement and frequent loss of income.

4. Wrong diagnosis / program code

The payer has an expert in their group to verify the authenticity of the claim and cross-check the CPT or HCPCS, which provides the diagnostic code for the treatment. In order to get more revenue from the payer, the biller often writes unauthorized programs and erroneous diagnoses. You should also be careful when using modifiers.

5. Double / fraudulent settlement

One of the most common wrongdoing attempts to obtain maximum reimbursement is fraudulent charging, which is the charging of unexecuted procedures. Sometimes upgrades also fall into this category. Billing personnel should be proficient in the latest coding standards to avoid coding in the old way. Downsizing is also tricky and can hurt your income.

6. Follow up the payer

The lack of follow-up to insurance companies is the most common list of medical billing errors that result in monetary losses in medical practice. The blame for employees is shorter working hours, the workload is increased, the main management tasks exceed billing, there is no time to answer each rejected claim, and follow-up can help flow into cash.

7. Ignore EOB

It is important to understand the benefits interpretation [EOB] issued by insurance companies. In addition to rectification, it is also essential to avoid these errors in future billing.

All of these errors will unnecessarily delay reimbursement to avoid tarnishing your practice image with repeated errors. If you need to deal with these issues, ask your billing partner for help avoiding these pitfalls to keep your cash inflows.

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