The pace of today’s world is blazing. Not only is there no time to stop and smell the roses, it often feels as though there’s no time to do the simple extra checks we should as a matter of course. Sadly this can be a grave and costly mistake for a medical billing company today. It is paramount for coders and practitioners alike to catch mistakes including typographical errors during data entry or errors in eligibility verification. Small errors can create big problems where missed payments for reimbursement keep the machine running.
Elimination of coding or processing mistakes at the claims level is the best time to catch errors before they start affecting your bottom line. Making sure your employer keeps the lion’s share of their income from claims processing flowing uninterrupted is paramount at this phase.
Medical Billing Errors & Their Prevention
If you want to keep your claims from being rejected or denied, try these simple solutions to these common medical billing errors.
Transposing Digits & Omissions
Transposing digits & Omissions are one of the easiest ways to cause a rejection or denial. It’s arguably the most human error because your brain works so hard to make things make sense. Your brain can easily ignore a simple switch between two numbers or missing data. This is especially common when entering dates.
To avoid costly delays or rejections make sure to double-check all numerical data before claims are submitted. To take this to the next level make sure you get a second set of eyes on the data during the process. More eyes mean fewer chances for errors & omissions to slip through the cracks.
Wrong Insurance Received Claim
One of the saddest and easiest to avoid issues is the wrong insurance company receiving the claim. This is especially common when the patient doesn’t have their card on them. This raises the risk of mistakes with insurance mailing address’ and payor ID.
To solve this common mistake make sure all office workers have access to the information. Make sure they can choose the right agent via the practice management system. Another simple way to help avoid this error is to check the patient’s insurance information at every visit. This also keeps everyone up to date on requirements such as treatment and specialist pre-authorization.
Code linkage is how medical necessity is determined at the paperwork level. If the diagnostic code and procedure code show linkage there is higher confidence in medical necessity and subsequent payment. If this is missing or inappropriate you guessed it: no payment.
Awareness is the key to making sure claims aren’t delayed or rejected. Make sure everyone is up to date on the codes and understands their uses. All personnel should be well versed in coding guidelines and coding linkages. When you have questions ask, don’t guess. Mistakes here cost time and money.
This is a far more common error than it should be. Patient ID errors can happen when the front office takes in the wrong data or when the data is entered by the medical biller. In either case, rectifying the error is the responsibility of the medical billing company which will have to resubmit after rejection.
Double-checking all patient information including names at each juncture would help to ensure fewer issues. Verifying patient eligibility to make sure the correct ID number is used would also do tremendous work in alleviating this issue.
Because procedure and diagnostic codes change, invalid codes happen when old codes are used. When codes change it is the responsibility of each practitioner to make sure their books and software reflect the most current changes in coding.
If you make sure your books are updated regularly and commonly filed codes are gone over for accuracy you can head off these foreseeable issues. Keeping up to date on any federal and state laws governing codes and regulations is paramount. Lastly, make sure irregular codes simply aren’t clerical errors.
When Is An Error Not An Error?
Accidents happen, and that’s why we need to be vigilant and constantly improve our ways to safeguard against errors. But, as we noted in a previous blog post on fraud and abuse, we need to be making sure the system isn’t being abused. Fraud in medical billing can often become a problem when liability falls on more than just the perpetrator and becomes a costly blackmark on the company as a whole. Keeping ourselves honest starts with everyone paying attention and raising questions when errors look like something else.