As patients arrive at your practice, your front desk staff ambassadors set the tone with a warm, welcoming check-in. Then, your techs care for them with precision and effective communication. However, none of this matters if the back-end processes aren’t handled with the same level of expertise. This section addresses common billing errors in medical specialties and offers strategies to avoid them.
The Complexity of Medical Billing
Medical billing is a complex process that can be difficult to navigate. Doing it incorrectly can lead to non-payment or delayed reimbursements, negatively impacting your practice’s revenue cycle and bottom line.
Your practice should focus on submitting clean claims to ensure timely payments. This smooth process benefits both your practice and the insurance companies involved, and it’s the ultimate goal for all medical specialties.
What Are The Common Billing Errors?
Common billing errors that a variety of medical specialty practices experience include:
Patient Information Errors
All patient data must be correct: full name, address, date of birth, and policy numbers. Even a simple mistake can cause a bill to be rejected. Whoever is tasked with entering this data must check their entries. Watch for misspelled words and transposed numbers.
Incomplete Documentation
This can include diagnosis codes, procedure notes, a lack of detailed medical records, and start and finish times. Be sure all necessary information is included.
Failure to Verify Insurance Coverage at Each Visit
It can be easy to quickly check in a long-standing patient without verifying their insurance or whether it has changed.
Lack of Prior Authorization
Never proceed with a procedure without the insurance company’s prior authorization/approval. If so, they will deny the claim.
Modifier Misuse
This is one of the most common errors in medical billing. It can include using the wrong modifier or failing to use one when necessary, which can lead to a claim denial and affect the reimbursement amount. Engaging a Medical Billing Service like Newland Medical Billing and Management can eliminate these types of errors and assist in getting timely reimbursement.
Upcoding
This is using a higher billing code than what was performed. Be scrupulous about this as it can be contrived as fraud, leading to audits and legal issues.
Unbundling
This uses separate billing codes for individual parts of a procedure that should be coded together as one service.
Duplicate Billing
Sending the same claims to an insurance company multiple times can incur red flags. This can happen on purpose or by accident. A certified billing service like Newland Medical Billing and Management can prevent this from occurring.
Incorrect Procedure Codes
Medical coding rules are constantly changing. The newest manuals with CPT or ICD-10 codes will eliminate incorrect procedure codes on invoices.
Failing to Bill For Services
Sometimes, services are not billed due to miscommunication or oversight. A regular audit performed by Newland Medical Billing and Management can prevent this.
What Are the Advantages of Using a Medical Billing Service?
When a professional billing service handles the billing for services, you can focus on caring for your patients.
- You will receive reliable billing services.
- It will streamline your revenue cycle so that you no longer have to concern yourself daily with the business end of your practice.
- There will be timely claim processing, ensuring fast, efficient billing.
- Using certified coders, your claims will meet payer guidelines.
- You will receive a monthly report.
- You will optimize your revenue cycle management RCM process.
- The service includes prior authorization assistance.
If your practice deals with a specialty, you will have the required billing expertise you need. Certain medical specialties like oncology, infectious disease, pulmonary and sleep medicine, rheumatology, and internal medicine have unique billing requirements.
Newland Medical Billing and Management can expertly manage these specialties, including chronic cases and conditions, regulatory and compliance management, biologic therapies, and care for all other medical fields.
Expert Medical Billing Solutions in Michigan
If you are looking for support and a partner with the needed expertise to help with the complicated medical billing process, look no further than Newland Medical Billing and Management. Contact us today and discover how we can help your practice. Call us at 947-210-5612 to get started, or utilize our secure online form.
Sources:
Medical coding examples that could cost you | American Medical Association
10 of the Most Common Medical Billing Errors | Elation Health
