So you studied medical billing and you’re ready to go to work. You should know there are plenty of pitfalls along the path to producing perfect patient bills and filing flawless medical claims.
The American Medical Association (AMA) estimates the medical practice billing error rate at a mere seven percent. However, a 2014 NerdWallet.com study found mistakes in almost half (49%) of Medicare claims. (The average is probably somewhere between the two.)
To ensure the medical bills you produce are as accurate as possible, here are five of the most common billing and coding errors to avoid.
Incorrectly Documenting Patient/Insured InformationMisspelling a name or entering a patient’s insurance ID or Social Security number erroneously can mean rejection of an insurance claim. This type of medical billing error happens all too often, in light of how many people handle a medical record from the moment an appointment is made to the day the billing office creates the claim. It’s great to work quickly, but make sure you verify information from appropriate sources—and review your work before handing it off for submission to a payer.
Unbundling Procedure DocumentationAnother medical billing red flag is itemizing components of a larger medical procedure. Bundled codes should be considered incidental to that overarching process. For example, a diagnostic endoscopy is often executed as a stand-alone procedure. But if the diagnostic endoscopy precedes a surgical endoscopy of the same type, per CPT® rules, the surgical scope includes the diagnostic scope. Only the surgical scope may be reported.
Duplicate BillingThis is yet another of the most common medical billing mistakes. Perhaps a doctor gave medication to a patient and both the doctor and a medical assistant noted it in the patient’s chart. The medical biller sees two separate entries for the medication and bills the payer twice. This is duplicate billing. Similarly, inserting an inaccurate quantity for medications or supplies is an easy medical billing mistake to make. It could be as simple as adding a zero at the end of a number (multiplying the quantity tenfold) or hitting “7-7” instead of “1-1” (multiplying seven times the actual quantity used). The lessons here are to question chart entries that seem illogical and to double-check that the quantity you input equals the quantity documented in the patient’s chart.
UpcodingUpcoding means replacing a procedure code with one representing a more serious diagnosis, resulting in an inflated charge. This is considered fraudulent billing, so your job as a medical biller is to enter codes on a medical claim with extreme care.
Ignoring a Provider’s Coding or Billing ErrorMedical professionals are human too, so they sometimes document patient encounters inaccurately. Maybe a transcriber misunderstood the doctor or the physician incorrectly notated a procedure. Perhaps a canceled test is included in the procedures list. In any case, it’s your job to alert the medical professional so they can correct the medical billing error.