Most Common Medical Billing Coding and Billing Errors

Most Common Medical Billing Coding and Billing Errors

Physicians Billing ServiceMedical billing and coding is a fairly complex field involving a wide range of rules, regulations, and laws, various types of separate coding systems, and a process that includes the input of a range of professionals. Yet, the most common mistakes made in medical billing and coding are fairly simple.Here’s a look at five mistakes that are often the cause for rejections and delays in medical insurance reimbursements. Medical billing and coding professionals should not make these errors. That is, as long as they receive the correct information from the healthcare practitioner.

Wrong Patient Identifier

This can occur if the coder puts in the wrong information or if the doctor submits the incorrect information to the billing company. In either case, if a patient’s identifying number is wrong, the medical claim will be rejected and will have to be corrected and resubmitted. It is the most basic and one of the most executed mistakes in the physicianbilling and coding field.

Submitting to Incorrect Insurance Provider

Sending a claim to the wrong insurance provider is probably the second most common error. Sometimes this occurs due to the fact that a patient has changed their insurance provider, but they forget to inform the doctor of this change. It may also occur due to a clerical error on the part of the medical practice or the coder. It’s usually easily corrected, but it can certainly delay payments from insurers.

Invalid Diagnostic or Procedure Codes

This use of the wrong or inaccurate codes is another ongoing problem and with the migration from ICD-9 to ICD-10 this year, it will probably increase greatly. Diagnostic and procedure codes must be submitted with a claim, they must make sense in correlation to the patient’s condition, and they must be the latest codes. The new system has five times as many codes as the old system, which was almost forty years old, and with all of those added, refined codes, medical practices, billing and coding professionals, and insurance providers will need some time to adjust. There will be delays in reimbursement processing.

Bilateral Procedures/Services Not Included

A doctor may forget to note that they ordered an x-ray, blood work, or a MRI. If they do note include that in their notes, the medical billing professional can’t be expected to include it. Thus, the way to avoid this mistake is for doctors to make sure that their SOAP notes are complete before sending them to the medical billing specialist and coding office.

Unbundling

When services are provided all at one time they are to be billed as a bundle. Bundling services together lowers the cost. Unbundling may occur inadvertently or, if done on purpose, it would be seen as fraudulent behavior. Once again, keeping accurate notes and providing the medical billing company with the proper bundling of services will help negate unbundling.

Professional Services Can Help

canstockphoto9049280If you’re struggling with reoccurring medical billing and coding mistakes, our medical billing specialists can help reduce and negate their occurrence. Contact Medical Practice Management Resources, Inc., for a free consultation where we’ll discuss your physician billing needs and offer insights into how we can help you avoid common medical coding and billing errors.

No Comments

Sorry, the comment form is closed at this time.

Our Expertise