Most Common Problems in Medical Billing and Coding

Medical billing and coding errors are one of the most common reasons that cause claim denials and physicians suffer a huge loss in revenue. According to a report from the U.S. Government Accountability Office, almost 30% revenue loss of medical practices results from medical billing errors. The nationwide rate of denials for procedures not covered under patients’ current benefit plans is around 19%. This makes a huge chunk of a practice’s earning that does not return due to problems in the billing. It is estimated that doctors in the U.S. leave approximately $125 billion on the table each year due to poor billing practices. It is especially a matter of grave concern for physicians who put all their energies in providing the quality care to their patients but losing a major part of their earnings due to poor billing practices. By evaluating rejected claims, physicians can easily narrow down the reasons that are causing the denials or rejections. These reasons can vary from practice to practice but some of the reasons are common to all.

Incorrect Information

The billing staff trust the information filled by the front desk officer. This information contains important details of the patient such as name, address, SSN and insurance details. Incorrect patient information is the most common issue found in the medical bills. There are instances of wrong insurance policy numbers and incorrect information of the physician that cause the rejection. Insurance companies use the services of clearing houses that can easily detect any instance of mismatched information. So, wrong information of the patient, provider or the insurance plan is easier to trace in medical bills.

Procedures Not Covered

It is necessary to check the patient insurance details to get details of the authorized medical procedures and insurance coverage. Patients’ insurance plan can change anytime and sometimes patients have no update about it. In this scenario, physicians use the information provided by the patient and without verifying it with the insurance company. Submitting a medical bill for procedures and services that are not covered by the insurance plan or for the services which required prior authorization can cause rejection. To handle such errors, medical billing staff mostly use the data filled by the front office. So, practices should train their staff to check for the insurance eligibility of the patient when the visit is scheduled.

Duplicate Charges

Duplicate charge is a type of medical billing mistake when practices bill for the same service more than once. There are chances that your billing staff is claiming a payment for procedures that have already been adjudicated for the same patient in another bill. Medical billers should be cautious when billing for multiple procedures and submitting the insurance claim for the same patient.

How to handle medical billing problems?

Identifying problems in your medical bills is just the one part. To make sure that your practice is getting maximum returns is only possible if you reduce them to a minimum. It requires a consistent commitment and improvement at various levels. Most of the practices prefer to outsource their medical billing to a professional medical billing company.

Employ a professional medical billing company

Although, outsourcing your medical billing seems as an extra burden on your budget but you would realize that it can set you free from many medical billing problems and your practice would achieve better financial goals. It’s quite difficult to hire high salaried billing staff and dedicate a team for this purpose when it involves the extra expense of training those resources, managing their taxes and compensations. Your billing team may not have enough time to follow-up denied claims. However, billing companies have dedicated resources, specialized medical coders and accounts receivable specialists. You don’t have to worry about managing human resources; billing companies would manage everything from claim preparation to claim scrubbing and submission to insurance companies. A professional medical billing company such as Sybrid MD can assist you in handling all billing related tasks. A team of medical billing experts, looks after the daily tasks, prepare claims, follow up with insurance companies and update practices about the cash flow with weekly and monthly reports. Sybrid MD utilizes advanced encryption technologies to protect the data of practices and strictly follows HIPAA rules which make the company an ideal choice in terms of safety, security and affordability.