Almost 30% revenue loss results from billing errors. These errors are the common cause for claim rejections by insurance companies, aka payers in the US. Medical billing is much beyond just documentation; it is the very means of revenue generation. Since the maximum percentage of a physician’s income is from the payers, the billing process should be devoid of the following common errors.
1. Incomplete Patient Information
When it comes to detecting the loopholes in a business, it is best to start with the basics. It is necessary to check for silly mistakes while entering the name, date of birth, gender of the patient in the claims as errors detected by the payers will result in rejection.
2. Lack of Patient Verification
Lack of thorough patient verification process reveals potential chances for revenue loss. A complete verification should include verifying how many policies the patient has, the insurance policy number and its coverage, the allowance limit of benefits, checking for authorization of procedures, etc.
3. Date of Service and Timely Filing
It is true that a thing as simple as mentioning the correct date of service is important is often missed and becomes the cause of denial of reimbursement. Not only that, the claims need to be filed within a specific period from the date of service if physicians want the payment. Missing that deadline results in delay in getting reimbursed and often loss of revenue.
4. Erroneous Diagnosis/Procedure Code
The payers have experts on their panel to verify the authenticity of claims and cross check the CPT or HCPCS, i.e. diagnosis codes with the treatment rendered. In an attempt to get more out of the payers the billing staff often codes unauthorized procedures along with wrong diagnosis. One should be careful while using the modifiers too.
5. Duplicity/Fraudulent Billing
One of the most common malpractices for trying to get maximum reimbursement is fraudulent billing, i.e. billing for unperformed procedures. At times upcoding too falls into this category. The billing staff should be well versed with the latest coding standards to avoid coding the old way. Downcoding too is tricky and can harm revenue.
6. Following up with Payers
Lack of following up with the insurance companies for rejections tops the list of the most common medical billing errors that cause monetary loss for medical practices. Blame it on staff shortage, increased workload, predominant administrative tasks over billing, lack of time for being on call for every rejected claim, following up can help the inflow of cash.
7. Ignoring the EOB
It is crucial to go through and understand the explanation of benefits (EOB) issued by the insurers. Apart from making the rectification, it is also essential for avoiding those mistakes in future billing.
All these errors delay the reimbursement unnecessarily besides risking tarnishing of your practice’s image in case of repetitive errors. Seek help from a billing partner if need be to handle these issues and avoid these pitfalls to keep the cash coming in.