Medical Billing Mistakes Independent Healthcare Practitioners Must Avoid

Medical coding errors cost independent medical practitioners a large part of their revenue. Many times, the wrong coding and billing have severe consequences on corporate reputation, prompting clients to withdraw their patronage. The American Medical Association also considers that medical coding errors fall into the categories of possible fraud and abuse.

This classification further stresses the legal consequences of medical billing mistakes. Considering the complexities of medical coding and billing, mistakes are not exactly rare or unusual. Even the most diligent of medical coding partners experience a fair share of claim denial and eligibility cancellations.

As an independent medical practitioner, watching out for these errors helps you maintain the reputation of your brand. The team at XyberMed has highlighted 5of the most common medical coding and billing mistakes responsible for claim denial.

  1. Failure to Properly Verify Insurance Status

The failure to properly investigate and verify the insurance status of your client pool is perhaps the biggest reason for claim denial. Oftentimes, patients are expected to fulfill some requirements if their insurance status must stay active. This explains why insurance status changes even for regular patients. Insurance claims are denied for clients without an active status. To avoid revenue leaks, make sure your billing partner consistently updates every patient’s insurance status. This is in addition to copayments, deductibles, coverage period, and status dates. 

  • Incorrect Patient Information

Payors require that billing companies submit the correct patient identification information before claim processing. Identifier information matches a patient on the Payor’s database, generating important payment records required for legal coverage. Submitting the wrong information might cause claim denial and a resultant revenue leak. To avoid this, make sure your billing company captures the right specifics for sex, name, social security number, and policy number. Be sure to list the primary insurance. Also, make sure the diagnosis code correctly matches the care service delivered.

  • Wrong Coding or Duplicate Billing

Insurance companies invalidate duplicate billings and deny payment on this basis. There is also a huge problem with medical billing companies using outdated codebooks. Using outdated coding books, including Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), and the International Classification of Diseases (ICD-9), might result in claim denial. In addition to using outdated coding books, inadequate documentation or missing bill documents also contributes to claim denial. To avoid these, it is recommended that you perform periodic chart audits, making sure your billing partner is correctly billing all services rendered.

  • Delayed Claim Filling

Not filling a clam on time can invalidate its payment. Depending on the insurance provider, the claim-submittal period differs and determines how claims submitted are handled. The Affordable Care Act put the claims-submittal period at 12 months, with the start date pegged at the date the service was provided. It is also important that claims be filled properly with all the supporting documents. Your billing partner must understand the different guidelines for timely filings.

  • Ambiguous Coding System

Operating an ambiguous coding system is another reason why claims get denied. Each diagnosis and procedure performed must be coded with specific code integers. There might be variables describing differentials under the same specialty; however, the coding system must be specific for each. Payors request specific coding for claims to be processed.

The reasons discussed here are important is you must understand why insurance providers deny claims. To help keep coding errors within minimal range, consider using the XyberMed comprehensive billing system designed for independent medical practitioners.

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