The number of medical billing errors that occur each year in the United States is alarming: According to an article in the Wall Street Journal, anywhere from 30% to a whopping 80% of medical bills may contain errors, and the number of practices experiencing errors in their own billing processes is expected to climb as more and more of them implement their own in-practice EHR programs and fail to thoroughly train their staff in system use. There are many reasons why claims may be rejected, but no matter the reason, billing errors can be costly both to patients and medical practices. Not only can errors delay payment, but they can also raise red flags that can result in an RAC audit.
Here are five tips to help ensure your medical billing process is accurate:
1. Verify insurance benefits. The lion’s share of errors could be avoided if providers would take this critical step each time a patient receives services. Especially when a patient returns on a regular basis, it can be tempting to use information that was recently entered; the patient’s insurance company have changed, terms of service may have changed or the policy limit may have been reached. For each patient – returning and new – it’s imperative to check with the insurer to confirm coverage dates and allowed benefits, as well as co-payments, the need for authorizations and other pertinent information that can affect your billing or result in an error.
2. Verify patient information. Even small errors in a patient’s name, birthdate or gender can result in a claim being denied. If the patient isn’t the primary policyholder, the relationship to the policyholder should be checked for accuracy, as well as policy and group number when required.
3. Check – and then re-check – diagnosis and procedure codes. Using the wrong diagnosis or procedure code can cause the claim to be rejected because the insurer believes, based on the incorrect code, there is a lack of medical necessity or the procedure performed does not match the authorization received. Make sure your office staff is using the most recent coding books and that all billing staff are properly trained in the coding process. Providing ongoing training and purchasing new editions of coding books as they are released may seem costly, but taking these steps can avoid much more costly errors in the future.
4. Write clearly – or implement an EHR system. It may be an old joke that physicians’ handwriting is pretty bad, but the joke stops being funny when claims are rejected due to poor penmanship. If the physician resists cleaning up his or her act, billing staff should be trained to question any codes that seem inaccurate or hard to read. Another option: Use an automated system for billing, but be sure your staff is properly trained in its use. Poor training is the leading cause of EHR billing errors.
5. Make sure you haven’t already billed for the service. Chart audits are an effective way to make sure bills are not submitted twice. In some cases, bills may erroneously be submitted for procedures or tests that have been cancelled or rescheduled. Chart audits also can usually catch these errors as well.
Proper training and extra care and attention by billing staff are the most effective ways to eliminate medical billing errors. Take the time to implement quality-control policies and programs and make sure your staff understands the steps they need to take to keep your practice’s billing and coding procedures as error-free as possible.
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