Common Medical Billing Errors And The Consequences Of Incorrect Coding

Most of the billing errors such as incorrect medical codes, duplicate bills, upcoding, etc. occur due to lack of experience and mere negligence. The use of incorrect or wrong medical codes can lead to some serious consequences you might not even be aware of. However, all the errors can easily be prevented simply by giving proper training to the billing team or by outsourcing the billing services.

Although the solution is quite easy, common billing errors are still prevalent. This article will talk about the most common medical billing errors, ways to prevent them, and the consequences your practice may face if incorrect codes are being used in medical bills.

List of the most common Medical Billing Errors:

• Incorrect Patient Information

This is one of the most common medical billing errors. The billing process begins generally with patient scheduling and registration. The billing team or the front office executive responsible for patient scheduling and registration needs to make sure to get the accurate patient information such as name, date of birth, address, sex, insurance information, etc. It will not just smooth the entire billing process, but help in claim approval as well. Advise your staff to cross-check the entire information in detail while entering the patient information.

• Incorrect or Duplicate Billing

If your billing team is a little inexperienced or does not focus on detailing, it can lead to the cases of incorrect and duplicate billing.

When a patient is mistakenly charged more than once for the same treatment, the cases of duplicate billing takes place. The cases of incorrect or wrong billing include mistakenly charging for the services that are not even availed by the patient.

Such errors may occur when the billing staff does not cross-check the information mentioned in the bill after the treatment is over. The billing team should be well aware of the treatment, procedures, and the services a patient has received to avoid such errors.

• Using Wrong Billing Code

Another commonly made billing error is using incorrect or wrong billing codes. The team needs to make sure of using an updated codebook to enter the correct medical code as an incorrect medical code will directly result in claim denial. Using wrong codes will not just reduce revenue but patients will also be dissatisfied. Make sure that the billing staff is not using outdated codebooks.

• Understanding EOB

EOBs (Explanation Of Benefits) are not that easier to understand. Make sure that your billing team exactly knows what was paid, and how and why a claim was denied. At times, the insurer pays only a partial amount for a claim. The billing team should carefully go through the EOB to understand why the insurer paid less amount and what should be the best way to resubmit a claim to get the proper claim amount. Also, the billing team needs to make sure that the insurer has paid the correct payment for all the codes.

Other Errors in Medical Billing

• Upcoding – When a healthcare provider submits incorrect/inaccurate billing codes to the insurance company to receive inflated compensations, it’s termed as Upcoding. The inaccurate codes indicate that the patient received the treatments that were costlier than what they actually received.
• Mismatching of Codes – Another coding error in medical billing is using a diagnosis code that is not compatible with the procedure code.
• Undercoding – When the codes used in the bill do not indicate the complete work or treatment performed by the healthcare provider! Undercoding may lead to revenue loss.

Nonetheless, it is important to avoid such common and frequent medical billing errors, as it may have some serious consequences as well, if your practice has a history of consistent use of incorrect or wrong codes or other billing errors.

Incorrect or wrong coding will only lead to a loss in revenue due to high denial rates and other relevant reasons.

• Your practice may come under the scrutiny of the medical fraternity or government medical bodies for wrongly using medical codes.
• Submitting incorrect or wrong medical codes, either deliberately or unintentionally, for a considerable number of patients, can lead your practice to be considered under medical malpractice.
• You can be booked under the False Claims Act (FCA) for submitting incorrect claims either to the government or private insurers.
• The result of Upcoding can be severe federal penalties and costly fines.

Considering the consequences, it’s vital for all the healthcare providers to understand that removing medical coding errors will lead to lower claim denials, and that will maximize your reimbursements and revenue eventually. The best way to practice error-free medical bills is either by training your medical team regularly or by outsourcing the billing and coding services to a team of seasoned professionals and experts like CAPLINE.