The number of medical billing errors that come up each year in the United States is no less than alarming.
According to John Hopkins study, 10% of the deaths in U.S. are due to medical errors; the third highest cause of U.S. is a medical error, and they are an under-recognized cause of death. A 2017 analysis found that out of the $3 trillion claims submitted in 2016, 9% were denied.
An article in the Wall Street Journal says, 30% to 80% of medical bills contain errors.
Did you know that high rates of claim denials and rejection can impact medical practice’s revenue significantly? It can wreck your credit score and also lead to a RAC audit.
Here is how you can help your staff avoid medical billing errors:
Understand the difference between denied and rejected claims
The denied claims are determined by the insurance companies to be unpaid. The rejected claims are not accepted, due to medical billing errors in them. Denied claims can be reprocessed in some cases, but the rejected ones can be resubmitted if you readdress the errors.
An insurance company rejects the claim when you input the wrong patient or insurance data. On the other hand, when they deny the claim, the official explains the reason for denial.
Weigh, whether your claims are denied or rejected, find the reason behind them and then work on them.
Always verify patients data
Even a small error such as patients name, gender, and birth date can lead to a claim being denied. If the patient is not the policyholder, check the relationship to the policyholder, and then confirm all the details for accuracy.
Input correct ICD codes
International Classification of Diseases (ICD) codes used today are both important and complex.
For avoiding medical billing errors, it is important that you document every patient encounter in detail, as much as possible. Keep all the patient records and data of all the codes you use.
Not only, it will reduce the errors, but in case of denial, you will able to appeal a rejection as well.
Confirm patients eligibility
There are instances when you are not aware that the patient is not eligible or his insurance does not cover the services you have already provided to him. These situations leave you with a stuck denied claim from the insurance provider.
Before you provide healthcare services, ask the patient to confirm with the insurer for any recent policy changes. You can also verify the same by using medical billing software or calling the listed insurer.
Avoid duplicate billing
While duplicate medical billing errors occur due to several reasons, one of the common issues is internal issues.
These issues include when you or staff member has submitted a claim more than once.
Your patient receives the same service from a different healthcare provider, but on the same date. You or someone from your team resubmits the claim that is not paid in 6 days to avoid timely filing denial issues.
To avoid duplicate billing, use chart audits.
The chart audits to ensure that the bills are not submitted twice and catch other billing errors as well.
Follow National Correct Coding Initiative (NCCI) edits
According to the American Medical Association, the centers for Medicare and Medicaid services made NCCI so that correct codes are followed.
These are automated prepayment edits found by analyzing every pair of codes billed for the same patient on the same date by the same medical practice. If there is an NCCI edit, the medical billing code with being simply denied. Follow edits according to the specifications and help your staff avoid billing errors.
Do not forget Current Procedural Terminology (CPT) codes as they are the U.S. standard with which you report almost every medical service, be it medical, laboratory, surgical or evaluation and management services.
Outsource your medical billing procedures
There are many medical billing software providers that help your practice resolve billing errors. GreenBills (HIPAA compliant) is a patient-friendly billing solution that helps medical practices create simpler and easy to understand bills for clients.
With the focus on processing the providers claim seamlessly, our main goal is to reduce the workload from medical staff and pave the way for further growth of the practice. For further details on our services, you can send us an email at [email protected] or call us at 888-274-3755.