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Common Medical Billing Mistakes


Apr 18, 2020 #health, #Medical

The process of medical billing is challenging. Even a minor mistake can take a toll on the final bill for the patient from the healthcare provider. There can be possibilities of legal issues arising due to such mistakes, which can ultimately prove costly for all parties involved.

The following are the common medical billing mistakes that can be avoided to ensure error free medical billing and coding:

  • Missing and Incorrect Patient Information

The claim needs to contain all the necessary information of the patient such as date of joining, date of accident, date of medical emergency, insurance details, valid policy number, and other patient demographic information. Maintaining accuracy in these patient details is important ranging from exact spelling of the patient name to the current validity of the information collected. Double checking these details and updating any changes will ensure seamless medical billing and coding for providers.

  • Coding Errors

All the codes which are entered into the claim must be specific and adhere to the medical coding rules and regulations. For this, the medical coders need to be trained regularly. This would help them keep up with the changing coding regulations. Following outdated codebooks will lead to claim denials due to incorrect coding. Therefore, medical billing and coding errors can be avoided using the correct medical protocols and procedures.

  • Delay in Filing Claims

After the entire medical billing and coding process is completed, the claim must be filed before the set deadline. The deadlines are usually set one calendar year from the start date of patient care. That is, if the patient starts their treatment on January 1st of this year, the claim submitted must be received by the insurance providers before January 1st of the next year. If the claim is submitted before the deadline but received after the final date, then the claim will be denied. This is why, ensuring error-free medical billing and coding process is necessary to avoid delay in submission of claims.

  • Duplicate Billing

Duplicate billing can happen in two scenarios- If the patient account is not updated when a medical procedure is cancelled or if the medical claim is resubmitted instead of being followed up. Other manual errors could also result in duplicate billing which would increase the cost of medical care for patients. This is another common medical billing and coding mistake that can have expensive and time-consuming consequences.

  • Absence of Prior Authorization

Prior authorization is issued by insurance payers for patients to avail medical services from physicians. It is a step that supports the necessity of medical assistance for the patients. If prior authorization is issued by the payer, it does not confirm that they will cover the costs for the patient’s medical procedures. Even then, this step of getting prior authorization from the insurance payers will quicken the medical billing and coding process since it supports the necessity of the medical procedure.

Mistakes in the medical billing and coding process will increase the probability of claim denials. It will cause inconvenience for the patients and delay revenue for the medical provider. The above common medical billing and coding mistakes can be carefully avoided to ensure timely reimbursements.

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