A consistent and stable revenue source is required to run a cost-effective, efficient medical practice. Unfortunately, if billing efforts aren’t optimized for success that will be difficult to achieve. Medical billing errors harm your practice, whether they result in late payments, rejections, customer complaints, or even missed productivity. Error elimination is vital to your bottom line, so consider the most prevalent medical billing problems and develop tactics to avoid them from affecting your revenue cycle management.
Top 5 Medical Billing Errors
Inability to Verify Insurance
The most common reason for claim denials is insurance concerns. Failure to verify is typically caused by an overreliance on routine. If a customer visits the office frequently, the staff may presume that their insurance provider or coverage plan hasn’t changed and may fail to confirm eligibility.
However, because insurance information can change at any time, you must incorporate a verification phase into the billing cycle for every patient visit. This entails looking at all four possible reasons for insurance-related denial:
- Coverage had been discontinued was ineligible
- Services that are not approved
- Operations that are not covered by the plan
- Maximum benefits have been obtained
By incorporating a stage in your medical billing system that verifies the patient’s insurance at each visit, you can ensure that there are no policy-related difficulties that could result in refused claims.
Incomplete Claim Information
A single blank or unchecked box on a claim can result in a denial. Even the most basic fields, such as:
- Time of the accident
- Medical emergency
Guarantee that an additional fresh perspective does a brief inspection of each form or electronic claim in your office files to ensure that all relevant fields are filled out. If you solely work with e-claims, make certain that your software system prompts users to examine missing fields and enter all essential information before enabling them to submit.
Lack of Specific information
Insurance companies frequently deny claims because they are not classified to the fullest level of specificity. Each diagnostic, as a skilled medical biller/coder knows, must be coded to the very greatest level for that code – that is, the maximum amount of digits for the code.
If your staff is unfamiliar with code, they might commit this type of mistake regularly. Hence, it is vital to educate your medical billers on the appearance of shortened codes so that they can correct them before filing.
Excellent Customer Service
Your medical billing software vendor should provide quality U.S.-based support services and ensure your team has a solution to any operational issues or difficulties in comprehending that arise. Providers who do not have or have limited access to great customer assistance are more likely to fail to optimize their software and use it to its full potential.
Incorrect Procedure Codes
If claims are regularly returned to your hospital because of inaccurate procedure codes, your employees may not be adhering to the most recent coding guidelines. Hospitals must minimize medical billing and coding errors to avert reimbursement complications. Continuous education initiatives, as well as other informal training sessions, can assist ensure that the staff is up to date on the most recent coding requirements and best practices.
Hence to conclude, Working with well-trained experts is the greatest approach to avoid obvious missteps. Outsourced medical billing services is one solution that has been shown to assist medical practices to maximize income by minimizing claim denial rates.
Business Name: Sunknowledge Services Inc
Sunknowledge, an ISO 9001:2015 and ISO 27001:2015 certified company, is a leading and global provider of medical billing outsourcing services in the U.S. healthcare domain.
Director of Business Development at Sunknowledge Services Inc
Phone: +1 646-661-7853