Medical offices are often fast-paced environments where common, even simple, mistakes can and do occur.
Sometimes, the staff is so focused on delivering gold standard patient care your practice is known for that these types of errors happen. Unfortunately, failure to follow practice and hospital medical billing guidelines can significantly and negatively affect your bottom line. Visit aha.org for a brief overview of hospital billing.
The medical billing service and coding experts at Coronis Health want you to be aware of the errors that most commonly occur with hospital medical billing because they can be avoided, which will save your staff time and increase your profitability. With our niche expertise and global capabilities, we help medical facilities get every last dollar so they can grow and stay independent. Below are five common medical billing errors our expert team can teach you how to avoid.
1. Duplicate Practice and Hospital Medical Billing
This occurs when a practice bills a patient at least twice for the same test, exam, treatment, or procedure. It is typically the result of someone at your office failing to determine whether the patient has already paid for the service. This can create extra administrative work for your staff as well as the payer, as it can look like the patient received multiple services in a single day when that is not the case.
2. Incorrect Billing in Hospitals and Practices
This problem occurs when a medical practice bills a patient for incorrect services or for ones that he or she never received. Wrongful billing also includes billing a patient for a service that was scheduled and then later canceled. Even omission of vital information on a claim can be a major reason why some claims are denied. These errors could be as simple as incorrect patient information or contact information for the provider.
The errors may seem small and easy to make, particularly for practices that manually handle their billing by paper. Although they are common for staff handling billing in hospitals and practices, they can negatively impact your center in three ways:
- Financial – Billing errors may leave your books showing more revenue than you are actually making. This means extra hours for your staff to diagnose and remedy the issue.
- Risk of Penalties – Despite these billing errors being simple, your practice can incur penalties for fraud, regardless of how inadvertent the errors are.
- Reputation – Even more important is the hit to your standing among your patients, fellow practices, and the community. After all, who will recommend a practice that bills twice for the same procedure or bills for a service that was never rendered?
Fortunately, there are effective ways to eliminate these errors. When practices use electronic software that categorizes billing, errors are no longer problematic, leaving your reputation and your bottom line intact. Coronis Health staff stay trained on all the leading billing softwares so we can jump into any facility’s system and start producing results right away.
Some hospital medical billing codes are designed to be used for a group of procedures frequently performed together. When these services are billed under separate codes, it is known as unbundling. It should be noted that unbundling is an illegal practice because it can inflate the profits for the practice or center, even when it occurs due to simple error. The consequences for unbundling can be severe.
The good news is there are ways to avoid the unbundling mistake. Stay up-to-date on billing and coding trends, as medical billing codes change frequently to abide by updated healthcare regulations, newly-discovered illnesses and conditions, and new treatments. Allow your staff the resources to be updated on all new codes and billing procedures. While it is somewhat time-consuming, it will save you time, money, and potential legal headaches in the long run.
4. Failure to Follow Hospital Billing Guidelines: Upcoding and Undercoding
Upcoding might occur in two different situations. In the first, a diagnosis is upgraded or inflated from a condition, such as moderate, to one that is more serious – i.e., one requiring a more expensive treatment or procedure. The second occurs when a patient is billed for a service that is covered instead of one that was administered because the administered service was not covered under Medicare. Either case can inflate your revenue by demanding higher payments than you should receive.
Undercoding happens when a provider leaves off a medical billing code for less expensive procedures in the hopes of avoiding an audit or to save money for a patient. Although it can occur due to simple oversight, it can appear suspicious and result in serious consequences for your practice.
What is the impact on your practice? Though each type of upcoding error can be attributed to simple clerical error, often due to being overworked or understaffed, the impact is similar to that of wrongful or duplicate billing; your practice can lose credibility, raise the risk of incurring penalties, and spend unnecessary hours repairing the damage.
The best way to avoid this issue is to have your staff get in the habit of double-checking their work, or have a checks-and-balances system in place that ensures the likelihood of such errors is reduced to nearly zero. By consistently following hospital billing guidelines, you can eliminate many of these headaches for your center.
5. Confusing a Denied Claim with a Rejected Claim
A claim found to be unpayable by the insurance company is a denied claim, usually due to billing errors, omitted information, or patient coverage. In some instances, denied claims are eligible for appeal and reprocessing. However, your staff will need to take the time to determine why the claim was denied before a reconsideration request will be accepted.
A claim with incorrect patient or insurance information or other errors can be declined, which is a rejected claim. Even transposed digits in a patient’s identification number can result in an insurance company rejecting a claim. These claims are never entered into the payer’s computer system. When the error is corrected, the claim will have to be resubmitted.
What is the impact on your practice? If hospital billing services errors or incorrect patient information are the result of staff oversight, a common occurrence for practices doing everything manually or without an appropriate software system in place, patients can lose trust in your practice and your staff will spend extra hours correcting the mistakes.
There are effective ways to minimize denied and rejected claims. Make sure your staff checks with you if they have questions about how to bill or for what service to bill. They can follow up with patients before submitting claims to make sure all information is correct. By doing due diligence in the beginning, you can minimize issues after claims are submitted.
Avoid Common Errors With Our Medical Billing Service
Coronis Health uses a high-volume, expert approach to helping you avoid common billing errors, or when mistakes are made, we correct them quickly and seamlessly. We’re a valuable resource with decades of experience that provides you with dedicated collection and claims processing, among other services, to help you get paid – quickly and easily.
We know the challenges in juggling high-quality patient care with the business of running a profitable practice. We have the experience and training to keep you profitable and grow your business, and we have the expertise and commitment to reduce and even eliminate common mistakes so you have a constant revenue stream unhindered by simple setbacks.
Contact us today to learn more about our medical billing services or to request a free financial checkup.