The goal of the medical biller is to ensure that the provider is properly reimbursed for their services. In the pursuit of this goal, errors, both human and electronic, are unfortunately unavoidable. Since the process of medical billing involves two incredibly important elements (namely, health and money), it’s important to reduce as many of these errors as possible. In this brief course, we’ll introduce you to some common errors in the medical billing practice.
Causes of Medical Billing Errors:
Super bills that are difficult or impossible to read for the employee(s) responsible for entering the information into the practice management system. If the provider is not readily available to answer questions and clarify, sometime it’s up to the employee to determine.
Getting up-to-date patient info: When a patient checks in, that’s the time to ask if there are any insurance changes, address changes, etc. The front desk employees play an important roll in the reimbursement process.
Untrained or inexperienced employees: Many providers don’t see the need to pay well for the billing and coding functions. For this they get untrained and inexperienced employees who are not proficient on using the practice management software or the insurance claim process. Hiring more mature and experienced staff may cost a little more, but believe me it’s money well spent. And that’s true also for a healthcare billing service.
Charges are not posted: Many providers don’t realize the importance of posting insurance and patient payments for successful healthcare claim processing. If insurance payments are not posted, you can’t bill patients for the remaining uncovered yet eligible charges, copays, coinsurance, etc. Nor can secondary claims be created.
This adds up to a lot of money: A provider also doesn’t know how the practice is performing financially. Without posted payment information, you can’t run the reports necessary to show accounts receivable, outstanding claims, which insurance companies are paying, etc.
Preventing Errors:
There are many things a medical coder can do to prevent errors. A coder should always double-check a patient’s address, date of birth, medical record number, insurance ID and other identifying information, as well as ensure that all CPT and ICD-10 codes are correct. You should also verify that the diagnosis and treatment codes match.
Never skip steps like insurance verification. They are an important part of the process. You must carefully perform research in the chart and try to find all of the medical conditions that a provider has treated a patient for during the visit. Coders also need to ask for clarification when details aren’t clear, so that each condition is billed for appropriately and accurately.
Even when you’re sure you’ve done things right the first time, it’s always important to perform a double-check. Read through the claim and make sure there are no errors before you send it. This second check will often prevent you from making simple mistakes.
When it comes to confirming insurance coverage, make sure you get all of the necessary details. Some of the things you’ll need to know are:
- If the insurance company mandates Preauthorization.
- The co-pay and deductible.
- Limitations on visits and coverage.
- Maximum coverage for the particular procedure.
- The address claims should be sent to.