Tackling the Most Prevalent Medical Billing Claims Errors

Medical billing and coding can be difficult because even small mistakes can lead to claim rejections and delayed payments. You might wonder if your medical billing department is filing claims accurately. Even a highly trained team can make errors.

Medical billing claims errors cause more claim rejections and payment losses and increase the risk of audits. These errors can harm your relationship with patients. The medical coding system in the healthcare industry today is complex, which makes errors more likely.

Coding errors in claims cost the United States about $20 billion every year. The problem with claim denials goes beyond just lost or delayed reimbursements. It also includes the expenses of fixing a rejected claim. Many companies prefer to give up on unclaimed claims rather than deal with the costs of resubmitting them.

So, how can you avoid claim denials and rejections? By understanding and being aware of common errors in clinical medical billing claims. Here are some examples:

Avoid These Common Errors in Medical Billing Claims

Incomplete Patient Information

Patient Data is Missing Most billing mistakes happen because important information is missing from the claims. Incomplete data, like the date of the accident, the patient’s full name, and the date the patient sought emergency care, often lead to billing issues. To avoid rejections, it’s crucial to carefully review all the details before submitting the claim. One helpful solution is to use a portal that gathers and stores patient records, making it easier to maintain essential information.

Missing the Deadline to File Claims

 One important mistake in medical billing is when you don’t file claims on time. The starting date for the patient’s treatment is the first day mentioned on the claim form. Therefore, it is necessary to submit the claims within the time limit set by the medical insurance company and not after the deadline.

Errors in Patient Information 

Another standard error in medical billing claims is incorrect patient information. Spelling mistakes in the patient’s name, wrong date of birth, or errors in entering insurance details can result in a higher percentage of denied claims. It is important to ensure that the policy number, payer’s identification, and other relevant information are accurate and sent to the correct payer.

Checking these areas, including patient data and insurance details, is crucial to avoid these errors. You can also prevent these mistakes using specialized medical billing and coding software. Verifying all the information you submit will reduce the number of rejected claims.

Mistakes in Patient Information

Errors in patient data are common in medical billing claims. Spelling mistakes in the patient’s name, wrong birth dates, and errors in entering insurance information often lead to more denied claims. It is important to provide accurate policy numbers and identification of the payer to the right recipient.

Checking these areas and verifying patient data and insurance details may take time, but it is crucial. Using specialized software for medical billing and coding can help avoid these errors. Ensuring all information submitted is accurate reduces the number of rejected claims.

Problems with Coding

Using outdated or incorrect codes by the biller or coder can also result in denied claims. Using old code manuals or superbills can cause delays in payment, ultimately affecting the Revenue Cycle Management. Additionally, insufficient documentation is considered an error in clinical medical billing claims. When coding and submitting claims, it is crucial to billing only for documented expenses. Insurance carriers may consider services as not performed if services are not recorded.

Checking if the Patient is Eligible

Medical billing claims errors occur repeatedly because they don’t check if the patient is eligible. It’s important to figure out if the patient’s treatments are covered or not. It’s easy to update the insurance information regularly. When a patient gets a service, it’s necessary to check their eligibility and make sure their plan covers the treatment.

Need for a Referral or Prior Authorization

Sometimes referrals and prior authorizations are needed, and it’s important to understand the difference between them. The Primary Care Physician gives a referral and sends the patient to another healthcare professional for treatment or tests. The insurance company gives authorization in advance for the needed service(s). However, having prior authorization doesn’t guarantee payment. The filed claim must:

• Clearly state the medical necessity.
• Have the correct filing process completed.
• Include approvals or references from the referring or approved doctor.

Final Thoughts

If you make a small mistake in medical billing, your claim might get rejected. New Medical England Billing knows a lot about claims, so they can easily check for errors. They keep an eye on your filed claims and follow up often, so you can figure out why your claim was rejected and fix the problem.

With the help of their great medical billing outsourcing services, you can handle medical billing and coding without any trouble. They also control and prevent common clinical medical billing claims errors.

FAQs

What is a billing error?

A billing error is when something wrong happens with your bill. It can be when a charge appears on your bill that you didn’t make or authorize.

What is billing control?

Billing control means the steps organizations take to ensure their billing is accurate, complete, and on time. It includes procedures, policies, and systems to handle billing processes.