How Billing and Coding Mistakes Rob Your Practice’s Income

Medical billing and coding mistakes are prevalent. They require significant time and effort. If your team fails to manage these challenges properly? You will lose money. You may face other dire consequences.

Unfortunately, even little errors cause severe damage. It ruins the claim and payment systems. These common blunders diminish transparency. They harm your patient relationships. Besides, authorities consider these blunders fraudulent. It is malpractice. It tarnishes your reputation and results in heavy penalties.

One in three practitioners gets sued for misconduct. Care providers make preventable errors in 3% to 15% of treatments. Misdiagnosis is another common malpractice. Cancer and infections are the most misdiagnosed. Prescription errors are also common. Insulin and morphine have the highest mistake rate.

You should focus on developing better solutions. Address these difficulties to improve operations. Fix those patient relations.

But the GOOD NEWS is here. This guide walks you through common errors. You won’t fall victim to them. So without further ado, let’s get started!

Frequent Billing and Coding Mistakes

We will discuss common billing and coding errors. We also share tips to help you overcome these challenges:

Inflated Billing (Upcoding): These errors occur when you charge for more expensive treatments than requested. This happens when coders enter inaccurate diagnosis codes. Providers often charge for a 45-minute talk when they only met for 15 minutes. This action exposes professionals to legal consequences. One psychiatrist paid a $400,000 fine and was barred from Medicare for this.

Tip: Constant education for all personnel reduces this risk. Stay current with the latest coding guidelines to remain compliant.

Wrong Procedure Codes: One wrong keystroke creates an inaccurate procedure. It saves faulty code in your system. This leads to erroneous information on your forms. It ruins the integrity of your billing. Facilities face denials because employees fail to follow rules.

Tip: Provide additional training and ensure tight adherence to the process. When staff know typical errors, they stop repeating them.

Double Billing: You face a duplication error if you bill the same procedure twice. It raises costs and forces a resubmission instead of a follow-up. There are two types:

• Exact duplicates
• Suspect duplicates
• 
  
  Payers handle these differently. Exact copies are denied immediately. Suspect ones are put on hold. Both waste your team’s time. In 2016, 46% of fraud cases involved duplicate billing. Tip: Wait 30 days after the receipt date before submitting again. Review the Remittance Advice (RA) first. Determine why the first claim was not paid.

Low-Ball Billing (Undercoding): Undercoding happens when a provider skips a code for a cheaper service. They do this to avoid audits or save the patient money. It might be a simple oversight. However, it looks suspicious and has major ramifications. Your practice loses credibility and faces penalties. It takes extra time to fix.

Tip: You can avoid undercoding by mentoring your specialists. Train them on relevant code sets and guidelines. Ensure they understand every yearly change.

Breaking Down Bundled Codes (Unbundling): Unbundling divides a single procedure into multiple smaller parts. Some facilities bill these individually to trick payers into higher fees. This act is unethical. It creates massive problems during audits.

Tip: When a single code covers the whole procedure, use it. Simply make your medical coders aware of this error to overcome it.

Incomplete or Wrong Data: This is a very common error. Organizations fail to deliver the right info to support claims. This results in an immediate denial. These errors include wrong info for providers, patients, or insurers. It happens when the department fails to match diagnosis codes to CPT or HCPCS codes. It also occurs when physicians do not offer proper diagnosis details.

Tip: Develop extensive documentation processes. Use electronic tools to improve accuracy. Ensure all relevant information is included before sending.

Switching Numbers (Digit Transposing): An unintentional switch between two numbers interrupts your payments. This issue happens when entering dates of birth or ID numbers. One typo can stall the whole system.

Tip: Instruct your employees to double-check every figure. Ensure your coding software gives prompts to examine data. This helps eliminate human error before processing.

Modifier Mistakes or Overuse: Misusing modifiers is a frequent mistake. Using the wrong one or skipping it results in denials. You may also face heavy penalties for overusing Modifier 22. For example, removing a lesion from an obese patient is harder. You might use Modifier 22 to show increased complexity. However, you must provide proof. You need documentation to show why the work was harder than usual.

Tip: Train your staff on the proper use of modifiers. They provide the extra info needed to process a claim. They explain why a specific treatment was performed.

Missing Prior Authorization: Failing to secure authorization before treatment results in denied claims. You must verify insurance eligibility at every single visit. These approvals are mandatory for specific surgeries and drugs. They prove medical necessity to the payer. Ensure your diagnosis and procedure codes align to secure these approvals quickly.

A survey of 200 providers found that 48% blame denials on authorization errors. Meanwhile, 42% of professionals rank code inaccuracies and eligibility as the top reasons for failure.

Tip: Always submit an authorization request before providing any treatment. This step eliminates the majority of possible denials. It also prevents unnecessary delays in patient care.

The Best Fix for Billing and Coding Errors

Billing and coding errors cause revenue leakage. Mistakes like upcoding or missing modifiers lead to denials and lost income. Here is how MedyraTech, your reliable RCM partner, helps you avoid these typical errors and boost your revenue cycle:

Accuracy Advocates: Our expert coders check documentation thoroughly. We ensure every diagnosis and procedure is coded correctly. This prevents upcoding, undercoding, and unbundling. You receive the correct reimbursement for the care you provide.

Data Defenders: We use strict entry methods to cut out missing info. Our team double-checks every detail. This stops errors like digit transposing from ruining your claims.

Modifier Mavens: Our coders are experts at applying modifiers. We ensure you get proper payment by using the right ones. We avoid the abuse or misuse that leads to denials.

Duplicate Detection: Our powerful algorithms scan for duplicate claims. We guarantee you are paid for each service only once. This maximizes earnings and keeps your claims history clean.

Partnering with MedyraTech gives you a team of experts. We focus on coding and filing. We catch and fix errors before they hit your bank account. We handle the complexity so you can focus on your patients.

The Bottom Line

This guide explains frequent billing and coding mistakes. It provides a roadmap to avoid these errors. This ensures a healthier revenue cycle for your practice.

Using these techniques helps you dodge common pitfalls. You will get the most out of your services in the future. However, it is hard to do this alone. You need a shoulder to lean on. MedyraTech is a professional medical billing company. We help healthcare facilities avoid these complications.