Billing errors can cost your practice money, time, and reputation. They can also lead to claim rejections, denials, audits, and patient dissatisfaction. To avoid these consequences, you need to train your RCM staff to identify and prevent the most common billing mistakes. In this article, we will discuss six of them and how to fix them.
One of the most basic but frequent errors is entering incorrect or incomplete patient information. This can include misspelling names, mixing up dates of birth, omitting insurance details, or using outdated addresses. These errors can cause claim rejections or delays in payment. To prevent them, you should verify and update patient information at every visit, use electronic health records (EHRs) to store and share data, and use software tools to check for errors before submitting claims.
Incorrect patient demographics are the most frequent errors. We face a lot of claim denials due to this issue. Nowadays EHRs are used to store patient data but someone has to manually enter the patient details in the system and during this error can take place. So one has to enter the data carefully and use spell check software can also help but it needs to be taken care of during data entry in the system.
Another common source of billing errors is using wrong or outdated codes and modifiers for procedures, diagnoses, or services. This can result in undercoding, overcoding, or unbundling, which can affect your reimbursement and compliance. To avoid these errors, you should keep up with the latest coding guidelines and updates, use accurate and specific codes and modifiers, and review your claims for consistency and accuracy.
Correct use of modifiers can really change the game for providers. By using correct modifiers denials can be reduced and there could be a boosting effect on revenue. Same applies for CPT codes. Billers and coders should have knowledge on latest updates and guidelines to avoid denials.
Duplicate billing occurs when you submit the same claim more than once for the same service or procedure. This can happen due to human error, system glitch, or misunderstanding of the billing process. Duplicate billing can lead to overpayment, refund requests, or fraud allegations. To prevent this error, you should track your claims and payments, use unique identifiers for each service or procedure, and avoid resubmitting claims without proper documentation.
Some services or procedures require prior authorization from the payer before they can be performed or billed. If you fail to obtain or document this authorization, your claim may be denied or reduced. To avoid this error, you should check the payer's policies and requirements for authorization, obtain and record the authorization number and date, and attach the authorization document to your claim.
Sometimes, billing errors can occur because of using the wrong payer information. This can include sending the claim to the wrong payer, using the wrong payer ID, or using the wrong fee schedule. These errors can cause claim rejections, delays, or underpayments. To prevent them, you should verify and update the payer information for each patient, use electronic claims submission, and use software tools to match the payer ID and fee schedule.
The last common billing error is lack of documentation. Documentation is essential to support your claims and justify your services or procedures. Without proper documentation, your claim may be denied, reduced, or audited. To avoid this error, you should follow the documentation standards and guidelines for your specialty and payer, use EHRs to capture and store data, and use software tools to generate and attach documentation to your claims.
Eligibility and Benefits Verification is one of the most important aspect in billing. This is the first step of billing. If a patient is not active for DOS or his/her plan doesn't cover the service than obviously claim will be denied. So this is the most important factor that needs to be done correctly.