Medical billing errors can be a huge problem for both patients and practitioners. Studies show that physicians who practice in an environment where there is not enough support staff or where there is not enough time spent on administrative tasks will have more medical billing errors than those who do not have these issues. This means that this issue is costing more than just money; it also has the potential to create inefficient processes, which may lead to longer wait times for patients in need of care.
Let’s take orthopedic medical billing as an example. A study found that 2-3% of orthopedic surgical procedures are unsuccessful due to medical billing errors. In addition to these statistics, the administrative costs for a healthcare provider can be significantly higher due to medical billing errors.
What Are Medical Billing Errors?
Healthcare organizations rely heavily on revenue generated from patient billing. Claims submitted by your practice may be denied by payers if they are either incomplete, submitted late, or contain errors. Errors in medical billing, no matter how small, can cause significant payment delays. Here are five examples of typical mistakes made in medical billing.
Failure to Complete or Lack of Required Documentation
To be reimbursed for some diagnoses, office visits, and surgical procedures, documentation may be required. Your claim will be rejected if the necessary paperwork is either absent or insufficient.
Insurance Changes
If a patient is seen rarely, they may switch insurance companies in between appointments. Claims submitted to the previous insurer will be rejected if billed to them. You will need to track the patient to rebill with the updated insurance information.
Slight Inaccuracies and Typos
Claims might be refused for various reasons, including misspelled patient names or incorrect insurance policy numbers.
Coding
There are many moving parts in diagnostic and procedure coding, and your practice may need to adhere to strict coding criteria to be reimbursed for claims. Similarly, some insurance companies insist on having all related treatments classified together rather than individually. As a result of the complexities involved in medical billing, many claims may be denied, which can be especially problematic for smaller practices that may not have access to as many coding and billing specialists.
Delays
Claims must be lodged promptly with several payees. Claims may be rejected if they are billed late, whether because of human error or inefficient systems.
How Can Incorrect Billing Affect Your Business?
The bottom line of your practice will suffer from billing mistakes. Claims that include errors, lack necessary evidence, or are submitted outside the allotted billing timeframe may be rejected by the payer. Resubmitting your claim after correcting things like typos or missing paperwork will delay your payment. Furthermore, your billing staff will need to dedicate time and effort to correct medical billing problems. Your billing team’s concentration on fixing prior mistakes may leave them with little time to submit new claims correctly, leading to a never-ending loop of denials. In the worst case, income loss could result from mistakes like late billing.
Patients may be less satisfied if their medical bills are incorrectly processed. Even if your team members are currently trying to rectify the situation, payers may notify patients of a claim denial resulting from a mistake on your practice’s part. The front desk must devote time and attention to calls from angry patients. Patients may look elsewhere for care if your office doesn’t address medical billing mistakes promptly.
Conclusion
Finally, medical billing problems might make your clinic an audit target. Practices with a track record of erroneous billing face heightened scrutiny from the Centers for Medicare & Medicaid Services and commercial payers through fraud-prevention and auditing initiatives. Audits are time-consuming to comply with, and too many of them could lower morale.