The financial health of an independent physician practice depends heavily on patient billing. Medical practices can lose revenue when billing errors are widespread, and penalties for common errors can financially destroy a hard-earned blooming healthcare practice. When billing mistakes occur in Medicare and Medicaid too frequently, the result can be a practice-changing billing ban and can include monetary penalties and legal consequences. The ramifications of consistent errors in medical billing should not be understated. Read on to learn more about how to avert the most common medical billing errors.
Maintaining a Healthy Revenue Stream
Coding and billing errors in medical practices can lead to revenue loss and compliance problems. The commonality in these errors is incorrect data entry, lack of information of payor policies, and utilizing outdated billing practices. Overall, medical code errors can cause financial and legal pitfalls for independent physicians.
Correct Information Results in Payment
Working toward a low claims denial rate has numerous advantages. Updating and submitting accurate payor information seems simple but keeping a busy practice running can be challenging. The fact is that medical billing errors are most often caused by inaccurate data input. As part of the billing process, both primary and secondary insurance must be confirmed. In many cases, request for reimbursement remains unpaid due to the patients’ healthcare coverage being assumed without verification. Even with long time patients, demographics can change, and a common mistake is assuming a patient’s coverage has remained the same without verification. This can easily result in a rejected claim that is more time consuming than maintaining a practice of regularly updating patient information.
Transposing numbers or a spelling error in a name can cause a claim to bounce. Implementing a thorough review process prior to claims submissions helps reduce medical billing errors and the constant fight against denied claims. Verify all patient names, policy numbers, date of birth, and ensure the address is spelled correctly. Simple errors like a missing apostrophe in a surname can cause a claim rejection. Patients expect to provide insurance information and are ready, it is important your staff is habitual in checking every patient has an accurate profile.
Double Billing or Failure to Bill
Although less common, duplicate billing does happen. Conducting checks and balances in your billing protocol can mitigate this risk. Sometimes, services are not billed due to simple miscommunications or failure to enter information into the EHR. Regular audits of services rendered versus billed services can aid both issues.
When the same healthcare service is billed more than once, it can result in an audit or even penalties for submitting incorrect procedure codes. A systematic approach and thorough review processes of billing departments can benefit from a third-party review to catch errors before claims are submitted.
Wrong Codes and Modifiers
Regular staff training that ensures compliance with coding changes is an effective way to resolve the issue of common medical billing errors that surround code modifiers. Modifiers are a workhorse in medical billing, especially those that are used for locum tenens assignments, billed as the Q6 modifier. This wrong use of modifiers can result in denials or even a dreaded audit that takes time, causes stress, and can result in severe penalties.
Deadlines and Deficits
Missing deadlines set by insurance companies for claim submission is completely avoidable. Ensuring timely submissions is crucial for maintaining a robust revenue cycle.There is no resubmitting missed deadlines, the opportunity for payment is gone.
Prior Authorizations Results in Timely Payments
Making the mistake of avoiding prior authorizations when necessary is a common cause of revenue loss. Authorizations are increasingly required for procedures to demonstrate medical necessity. A cohesive alignment of diagnostic documentation and resultant procedural code entry can smooth the authorization process.
Falling Behind on Current Regulations
Medicare and Medicaid regulations continue to change every year. Practices that use outdated codes are throwing away money. Outdated processes will most certainly result in rejected claims and even when resubmitted will financially impact the practice. Regular review and pattern analysis of medical billing denials makes it easier to correct and eliminate future errors.
Missing Chart Information
Although part of the everyday patient visit, simple failure to document essential medical information can wreak havoc in a practice. Practitioners crunched for time should avoid EHR copy paste and take the time to make sure each visit’s clinical documentation is correct. Visit notes, whether in person or by telehealth should be descriptive and supportive of any changes requiring additional fees for service. If new information is not charted, the services rendered will likely go unpaid and lead to loss of revenue.
Resubmitting Claim Denials is a Big Deal
Submitting a claim for service isn’t the end of the revenue cycle. During the claims process, practices should see claims through to reimbursement and monitor outstanding claims continuously for billing denials. Denials can accumulate quickly, particularly with new staff and regulation changes. Without diligent follow-up and automatic resubmission, denials can financially destroy an independent practice.
At Virtual OfficeWare Healthcare Solutions, with premier billing services and technology, our team tracks and follows medical reimbursements during the entire revenue cycle to promptly address any potential claim issues.
Keep your Coding in Check
The importance of coding accuracy cannot be overstated. Submitting incorrect procedure codes can be as innocuous as exchanging a pediatric CPT code for a similar adult surgical procedure but will result in multiple claims denials and a potential audit. Revisiting codes before submission will reduce the errors and the risk of denials and improve claims approval rates.
In healthcare, the term locum tenens is used to describe a temporary practitioner filling in for an unavailable resident provider. Practices often erroneously assume that services rendered by locum tenens will not be paid, this is a false assumption that results in revenue loss. Every employee who is involved in the billing process must understand how and when services are coded to maximize practice revenue.
The term “upcoding” means billing for a more costly healthcare service than what was delivered, and it is healthcare fraud. Mistakes can be made, of course, but in the medico-legal space it will likely be seen as an attempt to pad a bill for a higher reimbursement. Eventually, if continued and discovered, this will end badly. Watch, listen, and caution during your training, education, and internal reviews. Monitoring compliance programs can help catch upcoding habits early.
RCM Technology and Services Reduces Billing Errors
Advanced features now available in complete practice management solutions, which include EHR software and RCM service solutions that can help the independent physician automatically check for billing errors prior to submitting claims. As a result, the doctor’s claims rejection rate will reduce and benefit the practice’s insurance rates, patient retention, and more. Maintaining accurate EHR patient data reduces the potential for errors. Working with an effective billing solution partner is the forward movement of using technology to further reduce medical billing errors.
Revenue cycle management (RCM) digital solutions and resources can help maximize income for medical practices. In addition to providing a complete cloud-based medical practice solution automating billing workflows, helping to save time and money, Virtual OfficeWare Healthcare Solutions offers comprehensive RCM services identifying and resolving billing inefficiencies in a timely manner and optimizing healthcare organizations’ financial performance.
We’ve Got You Covered
Independent physicians can reduce their rate of medical billing rejections. Virtual OfficeWare Healthcare Solutions offers proven and effective claims reimbursement solutions with a strategic, customized approach to reducing billing errors and denials.
Our team of expert billing professionals are ready to assist you with a free consultation that can quickly simplify and improve your revenue management. We’re ready when you are, contact us today.
