Let’s face it - billing errors happen. Even the most careful people make mistakes, and medical billing is complex business. Still, denied claims and lost revenue due to billing errors can cost your organization revenue and may even upset your patients. Here are some of the most common medical billing mistakes and how to fix them:
Failing to Verify Insurance Coverage
According to a 2011 report from the U.S. Government Accountability Office, over 20 percent of private insurance claim denials occurred as a result of eligibility issues, which can be caused by everything from a patient's plan having expired to a small change in coverage.
Employ a real-time system for checking eligibility up front with your patients and also prior to submitting each claim for both Medicare and private insurers. This gives you an accurate picture of the patient’s eligibility and benefits, coverage type, deductible data and provider/service specific coverage information. If you discover the patient isn’t eligible for coverage upon date of service, you can discuss payment arrangements with the patient before service is rendered.
Most provider offices move at dizzying speeds, making duplicate billing one of the most common and understandable errors. Duplicate billing may result in a number of undesirable outcomes, not just denied claims and lost revenue, but your organization could be flagged for a fraud investigation.
Use data to identify and understand duplication billing trends within your organization. This helps you pinpoint exactly where your team is making mistakes, giving you more control to set goals and develop a plan to avoid duplicate billing.
Inaccurate Claim Information
Another common billing mistake, inaccurate information on a claim (like the wrong social security number, date of birth or misspelled name), will likely result in a claim denial. This also includes missing information.
Train your staff to double check claims for accuracy and missed information before they submit a claim. Create a culture of patient data quality with your registration staff, but don’t set zero-error expectation pressures on your team. Because people make mistakes, investing in a dependable system that automatically discovers errors and inaccurate or missing information can provide a substantial ROI.
Using Wrong or Outdated Billing Codes
If your biller or coder is using an outdated codebook or enters the wrong code, your claim may be denied. Using outdated codebooks will result in revenue loss.
When Medicare and payers release code updates, be sure you’re on top of it. Check on new medical billing protocols and understand how and why they may affect billing. If you’re still manually looking up codes, find automated tools that eliminate this time-consuming task.
From an organizational or departmental level, you can take other steps to streamline your billing and claims management:
Create a culture of quality and data integrity.
You can achieve this a number of ways, none more effective than getting staff buy-in. Ask your team to form a taskforce that analyzes billing trends or develops a chart audit system. Pick one or two “data champions” in your organization who take responsibility for data integrity and promote a denials prevention mindset.
Communicate, communicate, communicate.
Medical billing departments must efficiently share information, both internally and from external sources, to ensure everyone is up to date on issues, new regulations, training and processes.
Use automated revenue management and data analytics tools to streamline and modernize your approach.
Take advantage of sophisticated automated tools in the marketplace to help you be proactive, avoid mistakes, increase efficiencies and ultimately get your cash flow going in the right direction.