Avoid These 5 Common Coding and Billing Mistakes

At the core of your practice’s success is financials. While having the best team possible and establishing yourself as a leading provider in your community are important, ultimately business comes down to one question. Are you making money or losing money?

Unfortunately, 4 out of 5 medical bills (a staggering 80%) contain errors, according to Becker’s Hospital Review. We are only human, and everyone makes mistakes from time to time. When it comes to insurance billing, even the smallest mistake can have a huge financial impact. Here are five coding and billing mistakes that could be costing your practice time and money.

1. Unverified Insurance

Always, always, always verify insurance before providing services. Sometimes in the interest of saving time, a receptionist will allow a patient through without verification. Maybe the line in the lobby is long and they’re overwhelmed. Maybe they waited on hold with the insurance provider for ages before giving up and thinking, “I’ll check in a minute.” Maybe they trust a certain individual, or assume they’re insured because of a previous interaction. Whatever the reason, best practice is to make it a requirement to double check insurance beforehand.

2. Incomplete or Incorrect Information

Data entry errors are the most common type of mistake on claims, and they can be the most costly. Typos, misspellings, mistakes, not enough documentation, incorrect policy numbers, missing information, and incorrect quantities are all trivial errors that can lead to immediate claim denial. These mistakes not only hurt staff’s efficiency and productiveness, but can also be very expensive to remedy.

How to avoid?
Double check all information, always. By taking a moment to verify all the patient’s data, you’ll save yourself time down the road. Have a third party review information, or if you’re filing e-claims make sure your software flags any missing fields. Use of an electronic health record, or EHR, will cut down mistakes and errors made by staff.

3. Wrong Diagnosis or Procedure Codes

Another frequent issue that can lead to denials is if the diagnosis and treatment coding don’t match, or if the coding is not specific enough. With the industry constantly changing, most coders have a hard time keeping up with the latest codes. The use of outdated coding resources will certainly mean a loss of revenue.

To make sure information is correct from the very beginning, you should stay up to date on coding rules and modifications. Track what’s being updated, changed, and replaced, use the right modifiers, and always use the latest version of your software. The software you use is critical to your success. We highly recommend Eclipse and ChiroTouch.

4. Upcoding, Undercoding & Unbundling
  • Upcoding is the intentional misuse or exaggeration of billing codes that inflate payment owed for services.
  • Undercoding is when a patient’s bills don’t accurately show the service they receive. This may be deliberately done, to give a patient a deal. It could also be an unintentional mistake, a simple failure to accurately account for the full services provided.
  • Unbundling is when the provider separates related services that should fall under the same code. They’ll charge a la carte instead of a package code, with the intention to get paid more for services rendered.

These errors are common and sometimes accidental. If your employees are overwhelmed, inexperienced, or not up-to-date on industry changes, they may not even be aware that they are performing potentially illegal actions. Whether intentional or an innocent mistake, upcoding, undercoding, and unbundling can have a huge impact on revenue. Worst case scenarios may result in fines and criminal prosecution. Best case scenario? Consult or outsource to a specialist to answer questions and help ensure claims are billing appropriately.  At Money Tree Billing, we partner with our clients to reduce risk, minimize errors, and educate on common billing mistakes.

5. Duplicate Billing

Duplicate billing, or double billing, is when a procedure is billed more than once. Even in organized practices, it’s easy to accidentally submit claims for the same patient’s treatment. If someone fails to check that the original claim was submitted, or if someone resubmits a claim before hearing back on the initial claim, they’re guaranteed denial.

How to avoid?
Be careful not to bill for services more than once, and be sure to know when to re-bill vs. send a corrected claim vs. void an existing claim. This may seem obvious, but it’s important to keep a record of all submitted claims, especially if more than one person in your office is responsible for this.

So, do 4 out of your 5 bills contain errors?

These five common mistakes we’ve mentioned above will help you know what to watch out for to increase your cashflow. However, for ultimate peace of mind consider outsourcing your insurance billing needs to Money Tree Billing.

Our professional, detail-oriented billing experts will help eliminate mistakes that are costing you and your staff time and money. And with the best guarantee in the industry, you can rest assured that your practice is maximizing your revenue. To get started, schedule a call today or contact us.

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