Tuesday, January 30, 2024

How to correct medical billing errors

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How to correct medical billing errors in your medical billing business

Medical billing errors are prevalent.  However, if not handled immediately, they can be expensive, resulting in significant financial issues and income loss.

Medical billing can be difficult to manage in a small organization with limited time and resources. Because insurance billing is frequently the foundation of a company’s income stream, every scenario contributing to a rise in medical billing mistakes must be detected and corrected as soon as feasible. As a result, having an experienced medical billing provider is a huge benefit for any healthcare business.



Hospitals cannot be reimbursed for insurance claims submitted by many patients if medical billing is not done correctly. It is because many people claim to have healthcare coverage, but not all claims are real. As a result, any inaccuracy in the billing process should not be overlooked by the medical biller. Minor errors in medical billing and collection procedures may occur, but ignoring them is detrimental to the hospital’s revenue. As a result, it is critical to remedy invoicing mistakes.

You would double-check the statement and inspect each item purchased to confirm that the erroneous amount was removed. However, it is easier said than done when it comes to medical billing errors. Perhaps you’re seeking a solution to the topic “how to correct medical billing errors?”

It is a well-known fact that medical billing fraud and mistakes are widespread, and as a result, individuals should be cautious rather than paying their invoices without hesitation. According to Healthline, over 80% of medical invoices have mistakes, which should be reason enough to double-check your bills before purchasing them.

In our previous article, we discussed common medical billing errors. If you did not read that article you can go through it as well. Otherwise, you may be confused with some terms. However, today we are going to discuss how to correct medical billing errors. After reading this article, you should be able to figure out how to avoid medical billing errors in your business.

Why is it essential to reduce medical billing errors in your medical practice?

Medical billing errors can have a number of severe consequences for your business. The most visible issue is the rising denial rates. If your practice’s claims continue to be denied, your insurance reimbursements will inevitably fall. Given that many clinics run on sharp profit margins, even a slight increase in claim denials might risk your practice’s profitability.

A bill that is originally denied due to an error generally takes twice as long to process. And the time spent following up on it consumes time that could be spent expanding a practice or providing better services to patients.

Patients, however, suffer the consequence of high denial rates owing to billing mistakes. When a practice is unable to successfully charge insurance carriers, it is frequently forced to make up the gap by charging patients extra at the time of treatment.

Ways to correct medical billing errors?

To stay in business and develop, every successful medical practice needs a continuous flow of incoming money. Part of that involves ensuring that there are no billing problems that would harm the company’s bottom line. There are a few suggestions and strategies you can use to save money on your medical bills before you ever get them.

1. Patients’ documentation should be improved and kept up to date.

How can you expect to manage medical billing charges effectively if you do not have enough complete information on almost all of your patients? First, you will need to remind administrative personnel to double-check the patient’s insurance details at each appointment. What is the aim of this? For example, a patient may have changed employment and insurance companies, or the service provider may insure them.

Whenever a patient upgrades to one of the most costly plans with reduced charges or declines to a less expensive plan with much more significant out-of-pocket expenditures, the kind of insurance may also have changed. Take the initiative to explain the method as you update their information so that a surprise increased price does not catch them off guard. Make sure you double-check the registration details and personally identifiable information. All of these criteria must be present for the records of third-party payments to be validated.

2. Up- and under-coding should be avoided.

It’s tempting to assume that just insurance claims are fraudulent. Medical bills, on the other hand, can be manipulated in order to perpetrate fraud. It is at this point that the principles of up-coding and under-coding come into effect. Under-coding happens when a medical biller intentionally eliminates a service code from a bill. 

The technique of adding a fake procedure code to a bill is known as up-coding. The former helps a patient save money, whilst the latter collect more dollars from the patient. However, these can happen unintentionally and not on purpose. This is frequent for anybody who is new to medical billing and coding, feels overwhelmed by the volume of claims they are managing, or has not followed up with the latest industry developments. Check to see whether the insurance has been validated.

Insurance issues are nearly often the root cause of refused claims. When a patient comes in on a frequent basis, a staff person may believe that their insurance has not changed. However, if it has changed and no one verifies their eligibility, you may be in big trouble.

By incorporating a phase in your billing system that validates the patient’s insurance at each visit, you can ensure no insurance-related difficulties, such as terminated coverage, treatments not approved, services not covered by the plan, or optimum results achieved.

3. Enhance quality assurance

Avoiding claim errors is critical for the financial health of your firm. However, after a claim has been authorized, the invoicing and collection process begins. Therefore, medical providers can better manage their cash flow by posting and recording payments using generally recognized accounting processes.

Keeping a transaction record for each receipt and submitting it to the billing team can improve account balance accuracy. The log should include all required information, guarantee proper posting, and make it straightforward for a reviewer to confirm that the correct payment balances are transferring to the valid accounts.

A record should have the following key information:

  • Number of the account
  • The check/cash receipt number
  • Patient’s name
  • Referral reference number or service date
  • The payment amount has been corrected due to a billing mistake.

Benefits explanation is required : 

A claim may be denied for several reasons, including insufficient documentation and a lack of an explanation of benefits. To prevent rejection, the medical biller must include a description of benefits with every insurance claim.

4. Ensure that all of the data has been input correctly.

It is easy to make a broad error when actively involved in medical billing if you have other duties. Here are a handful of the most frequent ones to stay away from if at all possible:

  • Incorrect insurance, patient, or provider information (patient name, patient address, date of birth, and policy numbers)
  • Entering ICD-10-CM codes with an unusually large or small number of digits
  • In a particular claim, without entering any codes at all
  • Incorrectly submitting CPT codes

5. Avoid multiple billing.

Another method to minimize mistakes is to avoid billing for services more than once. Although this may appear to be a reasonably self-explanatory activity, it is easy to overlook if more than one person enters data. To minimize future difficulties, it is critical to verify every patient’s billing thoroughly.

6. Make plans to succeed.

Every insurance provider with whom your company does business would have its own set of restrictions. In order to establish a primary healthcare relationship, an insurance company may ask you to provide progress notes with new patient claims. On the other hand, insurers may require chart data to support follow-up treatments or non-standard literature reviews.

Enhance and expand employee training programs, and add elements that assist billing professionals in quickly locating critical registration needs and patient files. This guarantees that each carrier has the information necessary to address claims as soon as possible when you apply for them.

7. The Most Important Point

It is essential to teach your staff how to fix medical billing errors and give them the tools they need to perform accurate records management for the medical billing procedure. Hiring a competent medical billing service provider who understands the business’s ins and outs and has an established track record is the most intelligent method to go.

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