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.
That’s why billing and coding experts want you to be aware of the errors that most commonly occur because they can be avoided, which will save your staff time and increase your profitability.
This occurs when a patient is billed at least twice for the same test, exam, treatment, or procedure.
When a patient is billed for incorrect services or for ones that he or she never received. Wrongful billing also includes billing a patient for service that was scheduled and then later canceled.
Impact of the above billing mistakes: both are common, easy-to-make errors for practices that manually handle their billing by paper, yet they can negatively impact your practice in three ways:
- Financial – your books show more revenue than you are 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 amongst patients, fellow practices, and the community. After all, who will recommend a practice that bills twice for the same procedure?
How to avoid these mistakes: use electronic software that categorizes billing.
Unbundling is when billing codes that should be included under a single code are separately billed under different codes.
How to avoid this: 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.
This occurs when A) 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, or B) 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.
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.
How to avoid this: 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.
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.
A claim with incorrect patient or insurance information or other errors can be declined, which is a rejected claim. When the error is corrected, the claim can be resubmitted.
Impact on your practice: If billing 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, your practice can lose its trustworthiness with patients and your staff will spend extra hours correcting the mistakes.
How to avoid this: 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.
How Coronis Can Help
Coronis has used a high-volume, expert approach to helping you avoid common billing errors, or when mistakes are made, to correcting 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.