National reports show that 90% of medical bills have errors, according to Sheri Samotin, President of LifeBridge Solutions, a medical advocacy and elder care coaching organization. Medical billing errors are often the result of common mistakes such as typographical or data entry errors. Unfortunately, making even a simple mistake leads to significant time lost tracking down the source of mistakes, and serious delays in payments. Lost payments drain the lifeblood of a healthcare facility, which relies on a steady stream of reimbursements to keep going.
It is up to medical billers and coders, and effective communication with the rest of the office staff, to stop these types of mistakes before they happen. While billing mistakes are a common occurrence, if you’re above a 4 percent denial rate, the Medical Group Management Association thinks it’s time to reconsider your billing strategy.
Providers, payers, and patients rely on medical billers and coders to do their jobs accurately and without mistakes. As a medical billing specialist, it’s critically important that you minimize any coding and processing errors. Healthcare providers receive the majority of their revenue through the processing of successful claims, so any mistake you make could cost your employer. Errors in medical billing can potentially cost doctors, clinics, physician groups, and hospitals tens of thousands of dollars or more in lost revenues per year.
According to a NerdWallet analysis of 2013 hospital audits by Medicare, 49 percent of bills contained errors, and some medical centers messed up on more than 80 percent of claims to Medicare.
There are few steps that will help you to prevent medical billing mistakes:-
- Always verify insurance
Can you guess the number one reason why most medical billing claims get denied? Not verifying insurance can cost you money and time, which is why it’s important for you and your staff to be diligent with both new and returning patients.
Contact the insurance provider to check effective dates and coverage period, assess deductibles and copayments and check up on preexisting condition exclusions. Every policy has its limits, but avoids errors when a patient’s maximum benefits are met or is receiving services not covered by plan benefits.
- Check for errors in patient information
According to a University of Minnesota study, 30 to 40 percent of bills contain errors. Since it only takes one simple patient error to cause a frustrating billing denial, train your front billing staff to familiarize themselves with the patient chart.
Double-check basic insertions like patient name, policy number and whether the diagnosis code corresponds with the procedure performed. Denials caused as a result of these mistakes can be resubmitted, but anticipate a 30-to-45 day delay period.
- Claim automation
As mentioned earlier, a practice management system can automate much of the billing process and leave less room for human error. However, don’t rely solely on the system, seeing as it won’t post charge and printing reports for you.
Train your staff to keep up with demands by developing habits within the system. A practice management system is especially useful for independent, budget-conscious practices, which have to perform more work with fewer resources.
- Errors in Coding
Unbundling of codes, not entering the diagnosis code to the highest level or understanding operative reports are anathema to getting paid. We don’t blame you, however. Given the labyrinth of codes and charges that appear on medical bills during an extra busy day at your practice can set back your payments significantly.
With ICD-10 nearly upon us, coding to the highest level of specificity is imperative so get into the habit now. In the case of, say, diabetes, you must use a fifth digit to specify the variation: 250.00 for diabetes mellitus type two, 250.01 for mellitus type one and 250.02 for diabetes mellitus type one uncontrolled. It helps to use your practice management system’s scrubber, which will signal under-coded diagnoses. Furthermore, facilitate a dialogue between your billers and coders to ensure the former know what truncated codes look like.
Medical billing and coding is an important job, and you should take care to minimize costly errors. Though timeliness is paramount, you should always take the time to double-check both manual and electronic health records and forms for accuracy before processing them. By staying up-to-date with trends in the field, you can anticipate potential errors and head them off before they occur.