Medical billing and coding are essential parts of the healthcare process. However, they can also be difficult to handle.
Fortunately, there are some steps you can take to prevent these errors from occurring in your practice. These simple steps can help you avoid rejected claims, increase payments, and keep patients happy.
1. Don’t Bill for Services More Than Once
One of the most common medical billing and coding errors is that of billing for services more than once. This can be a result of a mistake by the person entering the codes for an insurance claim, or a typo in the policy or group number. These mistakes can cost the hospital money, as well as time and frustration.
In addition to the cost, these errors can also lead to claims being denied by both Medicare and Medicaid or other government health programs. When this happens, the emergency medicine group loses reimbursement revenue until they can resubmit a clean bill.
This type of error can be devastating to any emergency department. But it can be particularly dangerous for medical groups that are self-funded and don’t have an in-house billing team.
Another way to avoid medical billing and coding mistakes is to keep up with the latest coding rules and trends. This means updating your staff on new and changed codes, and making sure they understand what each code describes so they can correctly submit the correct claims.
While this can be a time-consuming process, it’s worth it to avoid claims being denied by the government and insurance companies. And this doesn’t just help the bottom line — it can also protect your practice from the threat of an audit for suspected fraud or abuse.
Another key to avoiding medical billing and coding errors is to ensure that all your medical services are covered by your insurance plan. This includes both in-network and out-of-network services. This will help you avoid surprise bills and save your health plan money.
2. Be Careful of Inadvertent Upcoding or Undercoding
When it comes to medical billing and coding, a lot can go wrong. Whether it’s a mistake in entering information or a code being incorrectly assigned, mistakes can cost a hospital revenue and potentially lead to fines and penalties.
Among the most common errors are those that involve upcoding and undercoding. These are both a violation of the law and should be avoided at all costs, especially when it comes to a practice that relies on electronic health records.
Upcoding occurs when a healthcare provider submits codes for more extensive procedures or services than those that were actually performed. Typically, this is done in an effort to get more money from payers or patients. It can also occur if a provider misconstrues the procedures that were performed.
Incorrect coding is a serious issue for many hospitals. It can lead to claim denials, loss of revenue, fines and penalties, and even impact patient care.
To avoid these mistakes, it’s important to keep up with medical billing and coding rules as well as new regulations. This can include training for staff or updating software.
Another way to avoid inadvertent upcoding is by ensuring that diagnosis and treatment codes match. This can be difficult for some physicians to do, but it’s a necessary step in ensuring accurate billing.
It’s also wise to double-check that the correct coding was used on each and every claim. Typos in any vital information, such as the patient’s name, insurance ID or account numbers, can cause serious problems.
In addition, it’s critical to keep an eye out for Medicare prepayment edits. These are automated systems that analyze multiple codes and determine which one should be paid. This is a major issue in both private and public Medicare plans, as it can result in denials of claims and inappropriate payments.
3. Be Careful of Duplicate Bills
Duplicate billing occurs when a provider bills for the same service or procedure more than once. This can be done through the use of individual codes for different parts of the same test or procedure, or it can also happen when a patient is billed for an entire bundled set of tests without actually having them all performed.
Fortunately, there are a few ways hospitals can avoid these errors. One is to ensure that staff members are trained on the latest coding and billing procedures. These changes are made frequently to comply with updated healthcare regulations, new treatments and illnesses, and new code formats.
Another way to prevent these issues is by reviewing all medical records and notes regularly. This way, errors can be easily spotted before they cause issues in the future.
Patients can also check their hospital bills to see if they contain any duplicate charges. They can also call their provider to ask for a copy of their electronic medical record or superbill, which provides details of all procedures they received.
When reviewing these documents, patients can also spot any procedures that were not completed or canceled, as well as any missing services. This can help them identify any overcharges or mistakes that may have been made during the medical procedure.
These mistakes can be costly for the patient and the doctor, so it is important for hospitals to take measures to minimize them.
In addition to avoiding these common errors, hospitals should make sure that they are verifying insurance coverage at every visit. This can help reduce the number of rejected claims and improve customer satisfaction by ensuring that insurance companies are not overcharging patients for treatments they weren’t covered for.
4. Be Careful of Missing Procedures
As the medical industry expands, so do the opportunities for errors in medical billing and coding. These mistakes can be costly and can even negatively impact patient care if they occur unnoticed.
In addition to reducing your overall revenue, medical billing and coding errors can also lead to fines and penalties. Having an experienced team that specializes in emergency medicine billing and coding can help you avoid these issues altogether.
One of the most common errors that hospital billers make is failing to link a diagnosis code to CPT – Current Procedural Terminology – which can result in claim denials or payment delays. This can happen when the physician doesn’t provide all of the information necessary to code a particular procedure.
Missing procedures are a problem for hospitals because they can delay the treatment of an in-house patient or cause complications. For example, if an alarm is going off in a ventilator and an attendant is distracted, they may forget to check it, which can delay the treatment of a respiratory illness.
This can be especially problematic in a busy ward where an alert sounds every few minutes. Attendants are likely to become desensitized to the noise and forget to check it, which can have disastrous consequences for patients’ health.
Another reason that hospitals should be careful of missing procedures is because they can affect their insurance reimbursements. For example, if a procedure was billed for more than once, it can cost you money and increase your overall claim amount.
In addition to these mistakes, hospitals should be extra careful to ensure that all of their patients’ records are accurate and complete. These can include contact information for physicians, insurance companies, and other important people. It can also be helpful to have a system for communicating with patients about their health records and the status of their treatment.
5. Be Careful of Incorrect Coding
Incorrect coding can lead to claims being denied, rejected or delayed, which can have a huge impact on your revenue stream. It also increases the likelihood of your practice being subjected to federal penalties and fines.
In medical billing, coding is the process of turning services you provide into billable revenue. Each service is assigned a unique Current Procedural Terminology (CPT) or Healthcare Common Procedure Coding System (HCPCS) code, and these codes are then submitted to insurance companies and other payers for payment.
However, if your staff isn’t properly trained, they may make errors that could cost you money. This is especially true if your employees aren’t familiar with the latest coding requirements.
The best way to avoid this error is by making sure that your employees receive proper training in coding and other related tasks. This will help ensure that your hospital’s medical billing and coding are accurate, compliant and timely.
Another key factor is to verify the patient’s insurance each time they visit your hospital or clinic. This is essential for maintaining a high level of accuracy, and it will prevent many insurance-related mistakes later in the billing process.
When it comes to coding, it’s critical to be specific about each patient’s diagnosis and procedure. This will ensure that you don’t have to rework the code later on in the process.
Incorrect coding is one of the most common reasons why claims are returned to hospitals. This is why it’s important to train your staff and use the latest coding manuals when it comes to preparing bills. These tips can help you avoid costly coding errors, improve your insurance reimbursements, and keep your patients satisfied with their medical care.