Medical Billing Errors That Can Lead To Claim Denials

Have you ever wondered how accurate are the claims submitted by your billing department? Given the new trends and complexities, it comes as no surprise that medical billing errors occur. They might not be major, but minor errors have become quite a prominent occurrence.

According to a University of Minnesota professor’s research published on HuffPost, 80% of the bills include incorrect information. The errors can lead to delayed payments, loss of revenue, and fines, during a lot of times. Even the smallest of errors can lead to these scenarios.

A NerdWallet study revealed 63% of Americans indicate that they have received medical bills that cost more than expected.

If your medical practice has been facing financial difficulties, it is time you review your claims. Here are some common medical billing errors to watch out for.

Unbundling of Codes

Unbundling refers to using multiple CPT codes, due to some misunderstanding or in an attempt to increase the revenue.

For instance, there is a five-digit CPT code for every medical procedure. Failure to enter any of the codes correctly can lead to a massive out-of-pocket expense for you. A Center for Medicare and Medicaid Services revealed that 42% of the claims that come for evaluation and management for incorrectly coded.

In case, if your claim has been denied, look for the coding errors.

Failure to Verify Insurance

One of the medical billing errors that lead to claim denials is not verifying insurance coverage on time. Some of the specific reasons include-

  • The provided services are not covered by the insurance plan benefits.
  • The maximum benefits are already met.
  • The member is not eligible for that service.

Make sure that you verify insurance on time and meet all the required rules.

Adding Incorrect Patient Information

While you are submitting a medical bill or claim, ensure that there are no inaccuracies in patient data. You can check the following details, ensure accuracy, and reduce the number of denials.

  • Have you entered the correct insurance payer?
  • Check the validity of policy number.
  • Review the patient’s details, such as name, sex, relationship status, and date of birth.
  •  If there are multiple insurances, check the accuracy of primary insurance for coordination of benefits.
  • Ensure that diagnosis code corresponds with the performed procedure?
Medical billing errors

If still your claim is denied due to inaccuracy, you can re-file the claim again. Re-files take 30-35 days to get paid.

Performing Duplicate Billing

Duplicate billing is filing a bill for the same medical test or procedure twice. There is a chance that you might be billing for the wrong service or service that you might have never performed.

In other cases, the patient denies the procedure, but it is never removed from the patient’s account. To prevent these types of medical billing errors and save the claim from denials, turn to chart audits.

Wrong Reporting of Time-Based Codes

The time-based codes include infusion and hydration, which are essential for the coders to bill for the services properly. For instance, if continuous hydration is given from 10 a.m. to 1 p.m., the two administrations should not report it as the continuous infusion, they should be reported separately as initial and sequential codes.

To avoid the entire above medical billing errors scenario, you can leverage an automated platform and improve your review efficiency and revenue cycle. There are numerous platforms that can help you quickly sort through the bills, make edits, and reduce the claim denials.

Designed to handle no-fault billing and collections, GreenBills is easy-to-use yet powerful software that assists you in managing your practice. The software comes with electronic bill compatibility, leverages smart referral scheduling, and easily handles large volumes of data without letting the data fall through the cracks.

For more details on our services, you can call us at 888-274-3755. You can also get in touch with us by sending an email at cl*****@ge***********.com.

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