There is no doubt that medical billing
errors can cause payment delays, rejection of claims, complaints, and loss of productivity.
Inexperienced billers cause tons of your claims slip through the cracks and doctors who work hard to take care of their patients don’t get paid. Common errors can cause claim denials, regardless of the size or specialty of your practice, clinic, and hospital. The article would address some of the most common mistakes in medical billing so that you can pay close attention to the impact it has on the local healthcare authorities.
If you file an incomplete claim, even a single unchecked box on a claim form can cause your bill to be denied. Mistakes as basic as gender, date of birth or even the date of service, if left blank can result in a claim denial.
Claim Submission Without Eligibility Verification
Failing to verify insurance benefits leads to denials. As a result, many practices end up providing medical services to un-insured patients. Claim denial would result in loss of revenue for the practice. Also, the patient who cannot afford to pay the bills would have to face a bad debt situation. There would also be a loss of productivity in man hours for the clinic to prepare and submit the claim.
Incomplete Claims
If you file an incomplete claim, even a single unchecked box on a claim form can cause your bill to be denied. Mistakes as basic as gender, date of birth or even the date of service, if left blank can result in a claim denial.
Coding Errors
Recent changes in medical billing and diagnostic coding systems can have an extra burden on small practices. Inexperienced staff may fail to recognize the appropriate codes or coding patterns, which can lead to claim denials. Such coding errors are common and it can happen at any point in the Billing and Coding process. This results in waste of time of resources and on top you don’t get paid.
Missing Deadlines for Claims Filing
Third-party payers may have different timelines; As a result, many practices do not maintain the cycle of awareness or spread information about the deadlines which are subject to claim denials. In some cases, previous claim denials caused due to other errors may also fall in this category of untimely filed claims. The third-party payers still reject the claims because the re-submission does not fall in the timely filing limit.
Documentation Required To Support Medical Necessity
Sometimes a payer requires medical records before it can adjudicate a claim. This may include the patient’s medical history, physical reports, physician consultation reports, discharge summaries, radiology reports and/or operative reports. Medicare and private payers recognize medical necessity as a deciding factor for claims payment and processing. The key is to have documentation to support level of service if records are requested. No documentation equals to no services performed. According to section 1862(a)(1)(A) of the Social Security Act, Medicare will not cover services that “are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.”
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