It’s easy and common to make mistakes while billing. But, sometimes it costs you big money and leads to some serious delays in payments. Paying attention while billing can help save big money and make it easy to avoid making those mistakes repeatedly. Medical billing mistakes are often the result of data entry errors or typographical mistakes.
Common billing errors and ways to avoid them:
- Use the right modifiers:
By now everyone must be or mostly accustomed to ICD-10. Using modifiers can be tricky and not using them can cause a claim to be denied. Not using the right modifier is the common billing error made by most individuals.
Make sure your staff is well-trained to use it to avoid making mistakes. Make sure to provide training to your staff on any diagnoses and procedures your practice uses often rather than wasting time in training and retraining staff on codes that you’re practicing don’t use.
- Bill the right payer:
It may sound silly but it’s very easy to make this mistake. Let’s take an example here: A patient name ABC comes in and gives you his/her medicare card. The front desk carefully records all the information and then the billing submits the charges to medicare. But unfortunately, the claim gets rejected, maybe even from a clearing house. What went wrong? The patient thinks his/her is on Medicare but his policy is actually with another Medicare.
The simple way to avoid this mistake is by verifying insurance at the time of check-in.
- Sweat the small stuff:
Leaving off any single required field can result in rejection. Before submitting the claim, make it a point to double-check that all the required fields are filled up. What’s trickier is making sure all the data in the required field is correct. It is also easy to make a mistake of misspelling a name or transpose numbers especially when you are too occupied at the front desk.
Despite the hectic schedule, make it a point to slow down and get this right in the first place. Then taking a little more time to double check. Keep yourself away from all the distractions to a minimum during this detail-oriented process.
- Run an analysis:
If you’re serious about getting everything right without making mistakes then it’s time to analyze your mistakes. EHR systems help you to customise reports. Whatever approach you take, make sure to look at patterns you follow that leads to making mistakes. Are you making any coding errors? Are those coming from billing or clinics?
Analysing your common mistakes can help you set your training priorities. If you haven’t taken a course or certification in a medical coding career, it’s time to take a medical coding course to get the job of your dream.
- Explain your decisions:
Another common mistake could be not getting prior authorization when payers require them for procedure and medications. Pre-authorization could be a big administrative burden.
If you have enough staff then assign one person in charge of this otherwise you might want to consider reviewing and adjusting workloads.
- Incorrect coding:
Every case that comes in office has its own medical code. Medical coding is a monster in its own rights. These codes are very specific and must be written down in it’s correct decimal point. For example codes 401.0 and 401.1 difference is benign and malignant hypertension. Each coding has its own medical representation so it’s important the numbers to be precise. It’s common to make such mistakes and it’s up to us to correct them. Earlier the recognition of the mistake, faster the correction would be.
You need to make sure, procedure codes and diagnosis code match in order to demonstrate medical necessity to the payers, failing to which the claim will be denied. To avoid common errors, hire staff and train them well. This applies to clinical and billing staff both.
Making mistakes is very common but learning from those mistakes to avoid repeating them in the future can help save money for your practice while improving your practice. It’s up to medical billers and medical coders, effective communication within the healthcare team to stop these kinds of mistakes before they even happen.
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