Common mistakes often committed by Medical Billing and Coding Companies

Common mistakes often committed by Medical Billing and Coding Companies

In the recent times some major medical billing errors have become common in the United States. When the government is keen in getting more involved in the healthcare field, disconnect and miscommunication are bound to occur between medical coding companies and healthcare providers – ultimately contributing largely to the artificial inflammation of your physician billing.

Everyone makes mistakes, and some of them can be forgiven and forgotten, but not when it comes to medical billing and coding errors. A single mistake could actually mean thousands of dollars in mismanaged costs for both a specialist and a patient.

Here’s a list of common mistakes often committed by top medical billing companies and coding professionals to provide you with an idea of where issues usually arise in the profession.

Upcoding:  The case of upcoding occurs when a medical billing code is changed to improper key representing a higher diagnosis and treatment. Please understand that this is termed illegal and can cause severe inflammation to a patient’s bill. Common examples of upcoding include coding for a name-brand medication when a generic medication is distributed to the patient, or as simple as coding a regular office visit as inpatient care.



Charges that normally fall together under one billing code that are listed separately, such is termed as unbundling. This may make your bill appear a lot higher as the items are not billed at a packaged rate. Should you notice any inflammation in your physician billing, consider speaking with a medical billing advocate.


Balance Billing:

The error in balance billing occurs when you receive a medical bill for the leftover balance after the claim has been submitted to the insurance company by the healthcare provider. You are required to check with the insurance company to see if all the charges are covered under the policy, and if they are, the balance bill is termed illegal to charge.


Duplicate Billing:

Such mistake occurs when a patient is billed multiple times for the same procedure or services. Instances such as when both a doctor and a nurse indicate that that a particular medication was delivered to you without having a knowledge that the same had been already billed. There have been times when patients were billed for multiple ‘first days’ in a hospital, which commonly cost more than following days during the same stay. This is the very reason why most of the medical bills are so high.


Lack of Medical Necessity:

At times, a care provider may fail to provide a medical coder with correct information about a patient’s diagnosis. The wrong medical diagnosis used on the bill could lead to the insurance company denying claim citing “lack of medical necessity,” and you may be charged by your doctor, directly.


Incorrect Patient Information:

There are also times when a patient’s name is misspelled or an insurance number is printed incorrectly – leading to the rejection of your claim. These errors are quite common unfortunately, owing largely to the fact that most medical bills are influenced by a large number of people handling one claim.


Mismatched Treatment/Diagnosis Codes: 

Mismatched Treatment/Diagnosis Codes occur when a medical biller upcodes a diagnosis, but makes no changes to the treatment code. In such cases, an insurance company rejects the claim as the treatment code and diagnosis code do not match.

Image Sources: Getty Images, Imgur

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