Common Medical Billing and Coding Errors and How to Avoid Them

Common Medical Billing and Coding Errors and How to Avoid Them

Medical billing and coding have been the core pillars of the healthcare industry. They have been an integral part of processing payments of healthcare providers, practitioners, doctors, physicians, etc. for the services they deliver to their patients. Although they are crucial, the whole process involves tons of complexities. These complexities can be revenue loss, claim denials, or something even more strict that can lead to potential legal actions due to medical billing fraud, etc.

A recent survey shows that almost $68 billion in revenue is lost due to simple medical coding and billing mistakes This is an alarming situation for the healthcare industry and that’s why, it must be addressed and taken care of immediately. This is why, in this article, you will learn the most common medical billing mistakes and how you can avoid them in your practice and save hundreds (if not thousands) of dollars in your revenue.

Common Medical Billing and Coding Errors

Incorrect Patient Information

First and foremost medical billing errors start from this simple step. When the patient first steps inside the healthcare facility, a practitioner first takes their information and stores it in their systems. But in this step, most healthcare facilities make common blunders like entering wrong information, misspelling names and addresses, misplacing digits of the contact number, etc. Although these are just minute errors, their impact is huge and long-term. These medical billing errors can lead to claim denials, inaccurate patient identification, birth certification, etc.
A study report shows that almost 35% of the total claims get denied solely because the practice puts wrong information about their patient in their records. This leads to further complexities like delays in payments, increasing administrative costs, etc.
The only way to prevent these types of medical billing errors is to be careful while taking patient information and putting it into the system’s records. Moreover, thorough, strict verification and conclusive medical billing audits must be conducted during the time of patient registration and claim submission to ensure all the information is correct and up-to-date. Plus, a practitioner should also consider investing in staff training to train them to record data accurately. This also helps immensely in reducing medical billing errors.

Wrong Coding

Although medical billing and coding go hand in hand, coding has a separate significance in the healthcare system and the mistake in this system can cost dearly. Medical coding errors are the most common and frequent errors. These medical coding errors occur when practices assign incorrect or incomplete ICD (International Classification of Diseases) and CPT (Current Procedural Terminology) codes for the diagnoses and treatments for the services rendered. Most of the medical coding errors stem from the use of old and outdated code books, inexperience or incompetent staff, or simple human errors.

Coding errors, although common, can be minimized by paying attention to the system that operates and assigns the codes. It’s important for a practice to update its coding records regularly and with the latest codes and information. Regular medical coding audits must be conducted to keep the claims clean and error-free. A provider should also invest their resources in training their coding team to utilize codes most efficiently and correctly. Providers can also invest in coding apps, like the MaxCoder app from MaxRemind, to keep updated information on the latest codes.

Duplicate Billing

Duplicate billing is one of the most common billing mistakes in the healthcare industry. This error occurs when a provider sends out multiple bills for the same diagnoses or treatment to the payers. This error most likely occurs due to a system failure, a bug, or simply due to human mistake. Duplicate billing is a somewhat dangerous error since it not only just puts claims on hold, it also causes billing penalties. In other words, gets practices in hot water with potential investigation of medical billing fraud.

As it is mostly a system glitch, what a provider can do is establish a strong system that oversees all the claims sent from the provider. This system should be so powerful that it could cross-check not only the errors but also the quantity of bills being sent to the payer. This system should make sure the bill is being sent only once. This can potentially reduce the chances of duplicate billing errors.

Failed Insurance Verification

One of the most abrupt medical billing and coding errors is not checking up on and verifying a patient’s insurance information before providing services. This is one of the most common medical billing mistakes that providers make. Insurance verification is important to make sure the insurance coverage is still valid, the plan is still active, and the service provided is still under coverage.

In an ideal case, the provider should verify the patient’s insurance on every visit. Providers can also use automated systems to check and verify patient information before providing any type of healthcare service. Suppose the patient’s insurance plan does not cover the particular treatment. In that case, the provider should promptly inform the patient and discuss payment methods to avoid any confusion and complexities in the future.

Not Outsourcing To Experts

Mot practices rely too much on their in-house healthcare administrative staff for medical billing and coding that they forget how much burden they’re putting on their shoulders. A hospital’s administrative staff can only handle a limited amount of tasks for their patients. Plus the administrative tasks and their complexities can sometimes become overwhelming. This behavior eventually leads to billing errors, claim denials, etc.
The only solution for this problem is to outsource your medical billing and coding work to experts like MaxRemind. With 20 years of combined experience in the healthcare industry, MaxRemind empowers your healthcare practice with expert medical billing and coding services so that you can focus on what matters to you the most i.e. your patients.
With more time and less stress on your side, you can treat more patients, establish meaningful relationships with payers and people, and increase your collective revenue.

MaxRemind also helps practices like yours with amazing AI-powered healthcare products like Maximus EHR, MaxRPM, MaxCoder, Max Charting App, etc. You can also consider MaxRemind for a wide variety of services like Healthcare Revenue Cycle Management, etc.

FAQs
What are the most common medical billing and coding errors?

The most common errors include incorrect patient information, wrong coding, duplicate billing, failed insurance verification, and lack of expert outsourcing.

What are the consequences of medical billing and coding fraud?

Medical billing and coding fraud can result in severe penalties, including fines, imprisonment, and exclusion from government healthcare programs. It can also lead to civil lawsuits and damage to a practice's reputation.

What is the importance of medical billing and coding audits?

Medical billing and coding audits are crucial for identifying and correcting errors, ensuring compliance with regulatory requirements, and preventing fraud. Regular audits can help practices maintain accurate records and avoid costly penalties.

What is the role of technology in preventing medical billing and coding errors?

Advanced billing and coding software can help automate many tasks, reduce human error, and improve efficiency. These tools can also help identify potential errors, streamline workflows, and ensure compliance with regulatory requirements.