Instructions to Avoid Expensive Medical Billing Mistakes

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By John Wick

Typographical and data entry errors are two of the most common causes of medical billing problems. Even a minor slip-up can end in a significant delay in your insurance claim payment. Building on these missed payments weakens a health care facility’s vitality, which is dependent on regular reimbursements. After all, it is the medical facilities that are responsible for avoiding these mistakes in the first place and communicating with the rest of their team effectively.

Accordingly, numerous medical coding jobs can help in dealing with medical billing. This write-up will explain how to avoid the most common mistakes and reduce the number of denied or rejected claims.

  1. Be Mindful Of Accidental Upcoding/Undercoding

Upcoding and undercoding (which are both unlawful and can result in fines or criminal punishment) are often done to benefit a practice financially in some manner. An example of upcoding is when a patient’s bill includes codes for services that the patient did not get. Undercoding is the practice of omitting codes from a patient’s bill to escape an audit.

However, this can also happen unintentionally. Inexperienced medical billers and coders dealing with a large volume of claims or who haven’t kept up with industry changes are more likely to suffer this.

  1. Medical Insurance Verification

Even the most regular patients’ insurance policies can change at any time, so it’s critical for a clinic to check their insurance before providing services. Failure to verify insurance leads to immediate denial of medical claims. Some of the most common causes for denials are service that is not allowed or covered by the plan, insurance that has been cancelled or is no longer eligible, and perks exceeding the maximum benefits.

Be sure that your team is aware of the need to validate each patient’s insurance, including the effective dates, coverage duration, deductibles, and copayments, to avoid these problems. The practice can save money, time, and effort by using software tools to perform these tasks.

  1. Employ a Billing Specialist

If your staff cannot handle billing procedures independently, they should consider outsourcing the task. This essentially makes up for the lack of adequate billing tools and qualified billers or coders while also giving the establishment a more professional outlook.

The change can largely be accredited to the fully qualified and certified consultants on the other end of the spectrum. Apart from this, it is further imperative to ensure your claims are handled by a professional who is always up to date on coding requirements and assures a 100% clean process.

The final result is that your personnel will no longer have to spend time on billing responsibilities, freeing them up to add efficiency in other parts of the administration.

  1. Validate Optimal Diagnosis and Procedure Coding

Incorrect diagnosis or procedure codes might lead to a claim being rejected by an insurance company. The error could be due to handwriting typos or outdated codes, among other things. Switching from a paper-based to an electronic health record (EHR) can enhance accuracy and eliminate errors.

  1. Adopt the Most Relevant Coding Manual

Regulations and laws are continually updating coding rules. Using a reference handbook that is too old can lead to denials, which can negatively affect the reimbursement process.

Keeping medical coders up to date on the newest billing standards and rules is critical to the success of any healthcare practice. To use the latest coding tactics, you need to keep up with the current coding books, such as CPT and ICD-10.

So, by staying on top of all the coding changes, healthcare providers can ensure that medical claims are processed quickly and without any money being lost.

  1. Submit Medical Claims by the Stipulated Deadline

If claims are not filed by their due dates, there is nothing that can be done since the most severe denials of appeal concern late filing.

To avoid missing these deadlines, keep a continuous list of the most prevalent ones and put up time-sensitive assignments for your personnel to audit unfiled claims. It is possible to resolve this concern by using a recurring calendar event or reminders.

Noteworthy Facts:

  •      80% of medical invoices contain inaccuracies
  •      Your employees’ productivity is hampered by high error rates, which can be costly to rectify
  •      If your staff is negligent and mistakes are made in any billings, you face the danger of enraging your devoted patients
  •      Data entry errors, incorrect code selections, and mismatches between diagnosis and therapy can all lead to mistakes in the medical record
  •      It is important to your patients’ insurance eligibility before giving services to avoid such mishaps
  •      It’s much easier to be paid on time if you use specialized medical billing software to find problems in claims
  •      Implementing EHR (electronic health record) software enables better data accuracy and better quality control

Final Thoughts

It’s no secret that medical billing is complex. However, if you complete all of your billing chores precisely and on schedule, cash flow and total reimbursement will greatly improve. Having a certified or well-educated billing crew is all you need to get the job done.

You can always outsource medical billing services if you find it challenging to manage them in-house, furthering your company’s overall financial operation and growth.