May 2, 2019 admin

Avoid 6 Most Common Medical Billing Mistakes Like a Pro

Finance is one of the most important aspects of any business. Messing it up is just not an option. Any business, big or small, has to deal with invoices, especially when you are in the healthcare industry. It certainly is important to ensure proper financing.

However, we are all humans. All of us make mistakes in our lives but that doesn’t mean that we should have to pay for each and every one of them, right?

Of course, making mistakes is natural and it’s definitely not a negative word. But repeating the same mistakes over and over again sure is stupidity.

So, let us learn about some common medical billing mistakes. And while we are on the topic, let us also learn how to avoid the most common medical billing mistakes.

What are the most common medical billing mistakes?

  • Upcoding
  • Unbundling
  • Balance Billing
  • Duplicate Billing
  • Lack of Medical Details
  • Incorrect Patient Information

Upcoding

A hospital can sometimes misinterpret the level of service or medical treatment, which can lead to an inflation of the medical bill.

For instance,

  • You could have been treated at a lower-priced service, but were charged at the highest level for it.
  • When the performed service is not covered in Medicare so the provider bills a covered service instead.
  • Billing for inpatient care when it is a regular visit.

These are a few examples of upcoding. These practices are fraudulent and illegal and should be taken care of on an immediate basis. Be sure to avoid these, to get your bill a green light.

Unbundling

Just as the word suggests, unbundling occurs when the services/charges, that fall under one bill, are listed separately. Such a practice can make your bill go higher since the items should have been billed as a package rate.

For instance; billing curry and rice individually would go higher than getting both as a combo. A medical billing company can assist you with such matters. You can consider talking to an expert regarding the same.

Balance Billing

The medical bill for the leftover “balance” after your insurance company negotiates the price with the healthcare service provider is balance billing. Run multiple checks to be sure of the charges covered under your policy. It is illegal to mention the charges that are covered, under the balance bill and you should not have to pay for the same.

In cases, where care is provided by an in-network hospital, balance billing is often improper. You can compare your bill with E.O.B. (Explanation of Benefits) to ensure no fraud.

Balance billing is most common in cases of out-of-network treatment and non-emergency care.

Duplicate Billing

The name says it all. Billing for the same treatment and tests more than once or for a wrong service or services that were never performed and the list goes on. At times, a certain procedure might be cancelled, but not removed from the bill.

Most of these mistakes are caused due to human error. Also, a lot of facilities are fined each year for committing fraud for the above-mentioned reasons.

The only way out of these errors is to keep a strict check.

Here, is a read that might interest you: Skyrocket Your Medical Practice Revenue with These 10 Tips

Lack of Medical Details

The lack of information through the service provider can lead to the wrong medical diagnosis code. Such medical billing errors can lead to denial of your claim because of “lack of medical details”.

Incorrect Patient Information

A spelling mistake or a typing error in your insurance card can lead you right away to the rejection of your claim. Of course, they are way too common, considering that they come from dozens of people. The most minute details are extremely important to ensure the processing of your claim in the first go.

Here is a list that can help you avoid such mistakes.
Double check the following things:

  • Patient’s name
  • Patient’s date of birth
  • Insurance payer
  • Patient’s sex
  • Insurance payer
  • Policy number validity
  • Patient relationship status
  • Correspondence of diagnosis code with the procedure performed
  • Procedure code for the service that was performed match the authorization obtained

Well, errors can never be completely stopped. But, the most we can do is be careful. With the most common medical billing mistakes, we have also put up a few ways above on how to avoid frequent medical billing mistakes.

We understand that avoiding such small mistakes is no easy. Need a hand? We, at Qodoro, would love to help you out with that.