15 Jun Less Common but Costly Medical Billing and Coding Errors
Medical billing errors are common. How common? Some estimates note that 80% of all medical bills have at least one error and, often, there are multiple mistakes on one bill.
Politicians, medical rights activists, consumers, and others have voiced concerns about the manner in which bills for office visits, hospital stays, and procedures are compiled and presented. Often, for consumers, they are presented in a confusing manner, as charges may be listed generally or in a manner that is difficult to decipher.
What Type of Mistake Is It?
Some errors are clearly mistakes made along the way, as doctors and staff document consultations, exams, procedures, and other services. There’s a lot of activity to keep track of and sometimes what occurred when can become blurred.
Also, there are those basic types of mistakes made by various personnel, whether it is a healthcare professional, office staff, or medical billing and coding specialist. These include common coding errors, which may, ultimately, result in a doctor being paid less than they should be.
Then there are errors that may not be errors, but, rather, may be interpreted as fraud, which includes charges that are added to bills for items that were never used, fees charged for services not rendered, or basic inappropriate billing practices. Although any error can be costly, these latter mistakes can be devastating for a medical practice.
Missed Rule & Regulation Changes
Although generally speaking, missed rule and regulation changes may account for a wide range of errors on bills, there are so many of these subsets of errors that it’s difficult to pinpoint any specific changes that tend to be the culprit. It’s important for you to keep up on any and all changes in medical billing and coding, however, it’s extremely difficult to do so. If your practice is affected in a major way by an amendment to a specific regulation, you can end up losing a lot of money. Often in-house billing services, which can be under a lot of internal pressure, fall victim to this type of costly error.
Billing for Services Not Rendered
Some physicians and hospitals seem to have their medical billing on automatic pilot. In other words, when billing for a specific service or procedure they include charges for various services that may or may not be performed on that specific patient. Although this is sometimes done out of habit, or due to the manner in which a billing system is set up, or due to an honest error, it is a practice that can cause a lot of trouble for those involved.
The results may include denial of numerous claims, audits of past claims, and an investigation by law enforcement. If a doctor has been billing in this manner for a long time, whether it is a glitch in their system, a miscommunication, or outright fraud, they may have to return any past payments received for such bills. Hundreds of thousands and even millions of dollars can be lost, and, if fraud is suspected, there can also be legal consequences.
Physicians need to monitor billing carefully and negate any charges for services, items, or procedures that were not provided. Ultimately, it is the doctor who is responsible for the bill that is sent in their name.
Again, sometimes the practice of code unbundling occurs due to miscommunication and other times it is a matter of fraud. If code unbundling, which occurs when a doctor charges for individual services that should, rather, be bundled together and billed as one entity, is detected by the insurance provider or government program, then the claim will be rejected. Plus, an audit and investigation of past claims may occur with the results possibly including the doctor having to return past payments, fines, and jail time.
Keeping a Clean Slate
It’s important for medical practices to ensure that their billing system is in proper working order. One way to manage coding and billing, and to cut down on errors, is to outsource the work to a company that specializes in this field. Keeping accurate records, auditing your coding and billing methods, and taking time to fix any problem areas that may trigger audits will help you avoid what can be some very costly billing errors and practices.
MPMR is the top medical billing firm nationwide for practices desiring to avoid mistakes and maximize their revenue. In addition to being a top physicians billing company, MPMR also provides incredible medical practice management consulting. This is different than what other companies will offer.
Call (951) 757-2056 for a free 30 minute consultation today!