Medical billing and coding problems are prevalent and require significant time and effort. If you and your medical billing and coding team fail to manage these challenges properly, you will lose money and may face other dire consequences.
Unfortunately, even little errors cause severe damage to the claim and payment systems. These common blunders diminish transparency and harm your patient relationships. Besides, authorities consider these claim blunders fraudulent or malpractice, tarnishing your practice’s reputation and resulting in heavy penalties.
- One in every three healthcare practitioners gets sued for medical misconduct while providing care.
- Care providers make preventable errors in 3% to 15% of all medical treatments.
- Misdiagnosis is another common malpractice, with cancer, infections, and vascular events being the most misdiagnosed illnesses.
- Prescription errors are also common. Insulin and morphine are the two drugs with the highest mistake rate.
As a result, you should focus on developing better solutions to address these difficulties to improve operations and patient relations.
But the GOOD NEWS is that this guide will walk you through all the common medical billing and coding errors and how to avoid falling victim to them. So, without further ado, let’s get started!
Common Medical Billing and Coding Errors
Here, we are going to discuss medical billing and coding errors and share tips to help you overcome these challenges:
Upcoding Claims
These errors occur when you charge your clients for more sophisticated and pricey treatments than they requested. These errors happen when coders enter inaccurate treatment and diagnosis codes.
Healthcare providers frequently charge for a 45-minute consultation even when they only meet with the patient for 15 minutes. Taking such action may expose the medical professional to legal consequences.
A psychiatrist was penalized with a $400,000 fine and permanently barred from participating in Medicare and Medicaid for upcoding errors.
AMA
Tip to Avoid This Error: Continuous education and training for all personnel involved in coding and billing can considerably reduce the risk of upcoding. Healthcare practitioners can guarantee their operations remain compliant by keeping up with the latest changes in coding guidelines and regulations.
Inaccurate Procedural Codes
A single incorrect keystroke on the keyboard initiates an inaccurate procedure, which saves a faulty code in the medical system. This incorrect code refers to erroneous information on the form, compromising the integrity of your billing system. Healthcare facilities may encounter claim denials or rejections due to employees’ inability to follow rules.
Tip to Avoid This Error: Educate your employees by providing additional coding training and ensuring tight process adherence to avoid these risks. When your staff is aware of typical code errors, it minimizes the likelihood of repeating the problem.
Duplicate Claims
You may encounter a claim duplication error if you bill the same procedure several times. It not only raises medical expenditures, but it also requires you to resubmit a claim rather than file a follow-up claim. Claim duplication has two types:
- Exact duplicates
- Suspect duplicates
The insurance payer company handles both of these claims differently. While exact copies are immediately denied, the appropriate authorities place suspect duplicates on hold. However, correcting both will require significant time and effort from your coding and billing team.
In 2016, 46% of healthcare provider fraud cases were caused by duplicate billing and invoicing for services not required.
Health Payer Intelligence
Tip to Avoid This Error: Wait 30 days after the claim receipt date before submitting another claim for the same service(s). Before submitting a new claim, review the Remittance Advice (RA) for the previously submitted claim. Also, try to determine why the first claim was not reimbursed.
Undercoding Claims
Undercoding happens when a healthcare provider skips a medical billing code for less expensive services to avoid an audit or save money for the patient. Although it could be a simple oversight, it can appear suspicious and have major ramifications for your practice.
What is the effect on your practice? The consequences are comparable to erroneous or double billing. Your practice may lose credibility, increasing the risk of penalties, and extra time is required to fix the error.
Over 50% of patients owe their providers $1,000 or more.
Fierce Healthcare
Tip to Avoid This Error: You can avoid undercoding errors by mentoring and training medical coders and billing specialists on the relevant code sets and guidelines, including yearly changes.
Unbundling Codes
Unbundling is a medical method that divides a single procedure into multiple smaller ones. Some healthcare facilities bill these smaller processes individually to trick patients and payers into paying greater fees. This act is exceedingly unethical and creates problems during audits.
Around 7% of medical billing errors are attributable to “Unbundled” charges, which are invoiced individually, even if they are part of the same service package.
Gitnux
Tip to Avoid This Error: When you have a thorough code for the entire procedure, you should run it all at once. You may easily overcome the situation by making your medical coders aware of the error.
Incorrect or Missing Information
The most common reason for this coding error is the medical organization’s failure to deliver appropriate information to payers to support claims, resulting in claim denial. These errors include entering incorrect information for providers, patients, and insurance companies.
Coding errors can arise when the billing department fails to match a diagnosis code to the CPT or HCPCS code. Second, employee errors might occur when physicians do not offer proper diagnosis information.
Tip to Avoid This Error: Providers should develop extensive documentation processes, contain all relevant information, and employ electronic technologies to improve the accuracy of claims and supporting documents.
Digit Transposing
An unintentional switch between two numbers while typing can interrupt claims and payment processing in medical coding systems. This issue occurs when entering numerical data such as date of birth or identification numbers.
According to studies, around 80% of medical invoices contain errors, with typos accounting for more than 25% of these inaccuracies.
Gitnux
Tip to Avoid This Error: You can avoid these errors by instructing your employees to double-check the entered figures. Ensuring that your coding software gives relevant prompts to examine the information before processing claims increases your chances of eliminating such errors.
Incorrect, Missing, or Overuse of Modifiers
One of the most common medical billing mistakes is the abuse of modifiers. Using an inappropriate modifier or omitting to use one when necessary might result in claim denials. Regular staff training on the most recent code changes is one of the most effective ways to deal with and prevent medical coding problems.
Besides, you can encounter claim denials or heavy penalties due to the overuse of modifier 22 (increased procedural services). For example, you remove a lesion from the neck crease of a severely obese patient. Obesity makes excision more difficult. In this situation, appending the modifier 22 to the code used to signal the removal can indicate the service’s increased complexity. However, you must provide adequate documentation to show why the method involves more work than usual.
Tip to Avoid This Error: Train your staff on the proper use of modifiers since they offer additional information required to process a claim, such as determining why a provider or other qualified healthcare professional performed a specific treatment and operation.
Lack of Prior Authorization
Failure to secure prior authorizations and verify insurance eligibility before treatment may result in denied claims. It is critical to have a system in place for checking insurance coverage during each visit. These authorizations are mandatory for specific operations and drugs to demonstrate medical necessity. Ensure that diagnosis and procedure codes are aligned to help you get these authorizations.
A survey with 200 healthcare providers found that 48% of professionals believe denials happen due to authorization errors. Contrarily, code inaccuracies, and provider eligibility were ranked the top reasons for claim denials by 42% of providers.
Becker’s Hospital Review
Tip to Avoid This Error: Always submit an authorization request for medical services before giving treatment. Following this step will eliminate the majority of possible authorization denials and avoid delays in patient care.
The Ultimate Solution to Medical Billing and Coding Errors – MediBill MD
Medical billing and coding errors can lead to revenue leakage. These mistakes, which range from upcoding claims to missing modifiers, can result in denials, delays, and lost income. Here is how MediBill MD, your reliable medical billing and revenue cycle management (RCM) partner, will help you avoid these typical errors and improve your revenue cycle:
Accuracy Advocates
Our expert coders thoroughly check documentation to ensure diagnoses and procedures are accurately coded. It prevents upcoding, undercoding, and unbundling claims, ensuring you receive the correct reimbursement for rendered care services.
Data Defenders
We use stringent data entry methods to reduce incorrect or missing information. Our team double-checks all details to avoid errors like digit transposing, which can undermine claims.
Modifier Mavens
Our coders are adept at applying modifiers. We ensure you obtain proper payment by identifying and providing all appropriate modifiers while avoiding abuse or misuse, which could result in denials.
Duplicate Detection
Our powerful algorithms thoroughly check for duplicate claims, guaranteeing that you are only reimbursed for each service once. It not only maximizes earnings but also ensures a clean claims history.
Partnering with MediBill MD gives you access to a team of experts dedicated to coding and claim filing. We detect and correct errors before they affect the practice’s financial health.
Besides, we manage the intricacies of medical billing so you can focus on providing quality patient care.
Bottom Line
This guide aims to help you understand the common medical billing and coding errors and provide a roadmap to steer clear of most of these while ensuring a healthier revenue cycle.
Using these techniques will help you avoid typical medical billing mistakes and get the most out of your services in the future. However, without a shoulder to rest on, it is difficult to put all of these tips into action. MediBill MD, a professional medical billing company, can help healthcare facilities avoid medical complications.
