There is no doubt that medical billing errors can cause payment delays, rejection of claims, complaints, and loss of productivity.
When newbies handle medical billing, lots of claims slip through the cracks. That means hardworking doctors who take care of patients don’t get paid. These common errors can lead to claims being denied, no matter how big or specialized your medical practice is. This article will point out these common mistakes in medical billing so you can see how they affect local healthcare authorities.
Filing an incomplete claim can lead to trouble. Even missing just one checkbox on the claim form can get your bill rejected. Simple stuff like forgetting to mention gender, date of birth, or the date of service can also result in claim denial.
Common Medical Billing Mistakes
Claim Submission Without Eligibility Verification
Forgetting to check insurance benefits can cause problems. It often leads to denied claims, which means many practices end up treating patients who don’t have insurance. When claims are denied, it not only costs the practice money but also puts patients in a tough spot with unpaid bills. Plus, the clinic ends up spending extra time preparing and sending claims, which can slow things down.
When you submit an incomplete claim, even missing just one checkbox on the claim form can get your bill rejected. Simple stuff like forgetting to mention gender, date of birth, or the date of service can also lead to claim denial.
Small medical practices can struggle with recent changes in how medical billing and diagnostic codes work. Inexperienced staff might have trouble with the right codes or patterns, and that can lead to claim rejections. These coding mistakes happen often, and they can pop up at any stage of billing and coding. This not only wastes time and resources but also means you don’t get paid for your work.
Missing Deadlines for Claims Filing
Insurance companies often have different deadlines, and many practices miss these dates. This happens because they don’t keep track of the timelines or share information about the deadlines that can lead to claim rejections. Sometimes, claims get denied because they were filed late, and this can result from earlier errors. When you send a claim again after a denial, it might still get rejected because it doesn’t meet the timely filing limit.
Documentation Required To Support Medical Necessity
At times, insurance companies ask for medical records before they approve a claim. These records can include a patient’s medical history, physical reports, doctor consultations, discharge summaries, radiology reports, and operation notes. Both Medicare and private insurance companies consider medical necessity when deciding to pay claims. The key is to have proper documentation in case they request it. If you don’t have the right paperwork, it means they won’t pay for the services. According to the Social Security Act’s section 1862(a)(1)(A), 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.”
The most effective solution for tackling your medical billing mistakes and errors is to team up with top-notch medical billing professionals and experts, such as GreenSense Billing (GSB). GSB hires the finest medical billing experts who follow clear processes and protocols, including internal audits, to ensure that every medical claim is error-free and gets paid.