5 Common Medical Billing and Coding Mistakes Costing Your Medical Practice Money

Medical billing and coding errors are costing doctors and patients approximately $68 billion annually unnecessarily. As a healthcare provider, you deserve to be compensated for the service and care that you provide to your patients.

Unfortunately, billing errors are more common than you could think, and even the smallest codling mistake continually made can make a negative impact on your organization’s financial bottom line.

Given the fast pace of changes with medical coding updates, combined with insufficient training, these errors will continue to be an ongoing issue.

Is your practice experiencing an increase in financial difficulties? If so, it may be time to review your previous and recent insurance claims to see where you might need to make adjustments.

To help increase your practice’s overall bottom line revenue, here are five medical coding mix-ups that are needlessly costing your medical office.

1- Not verifying a patient’s insurance coverage

Verifying your patient’s insurance information is a crucial process in maximizing your office’s revenue. A patient’s health insurance can change at any time, sometimes without the patient, even knowing about the recent policy revision.

Insurance coverage varies significantly with each policy making it even more imperative to check every patient’s insurance information at every visit.

The last thing you want is an enraged patient with an unpaid medical bill due to limited or inactive insurance coverage. Double-check all patient’s insurance coverage and save your healthcare business reputation.

2- Incorrect Procedure Codes

A simple keystroke slip can result in the incorrect entry of a procedure code. With a hectic medical practice documenting information incorrectly on encounter forms or other supporting documentation is a common occurrence even on digital forms.

An example of this is a patient’s insurance may have been charged for a bilateral lower leg venous ultrasound, but what they had was a unilateral left lower extremity examination.

Constant incorrect coding will eventually flag potential compliance issues with CMS and other health insurance providers.

3- Mismatched Treatment/Diagnosis Codes

Is your medical practice receiving too many rejected medical claims? If this is a common occurrence, then it’s most likely due to your medical biller upcoding a patient’s diagnosis without changing the treatment code.

An insurance company will usually reject the claim because the treatment code and diagnosis code does not match. Occasional upcoding is an error that can be avoided and changed.

Upcoding will provide overpayment of reimbursement to the healthcare provider, although it is not a legal practice. Remember, upcoding is considered a criminal act that costs patients and insurance companies thousands of dollars.

4- Unbundling Of Codes

Some procedures, exams, or blood tests have a single billing code that includes all components for payment that is considered bundling.

Unbundling occurs when CPT codes that would typically be grouped under the same code are listed separately, therefore, inflating the patient’s bill.

This practice increases the initial reimbursement, but it is not an appropriate billing practice. Unbundling is a compliance issue and can result in the payer clawing back money from the practice in the future. Avoid patient paybacks from spiraling out of control. It is suggested to assign one individual administrator to monitor all patient’s information and proper billing codes and descriptors.

5- Insufficient Data

Proper documentation, whether it be on paper or digital, is a necessity that shouldn’t be avoided. Insufficient data error occurs when the medical organization fails to provide relevant information to the insurance company to support the medical claim. Ultimately the medical claim will be rejected.

Administrative or technological activities can cause these mistakes. It can also occur when there’s miscommunication, and the physicians fail to provide accurate diagnostic information.

The omission of simple details like the patient’s name, identification number, address, or birthday can create a delay of potential reimbursements by the insurance provider.

Eliminating medical coding errors entirely can be challenging to do in a healthcare system that is continually evolving and fast-paced. Make sure your staff has access to the right tools, like training webinars, updated CPT coding books, and website links. Identifying erroneous billing activities and potential abuse will help your practice to achieve long-term financial opportunities to increase your medical office revenue.

BrightDrive Healthcare Solutions can help you analyze your revenue processes. We can additionally help you streamline your medical coding and billing system. If you are interested in outsourcing your medical billing and coding services, give us a call today to inquire and find out how to receive a free business revenue analysis.