As a healthcare provider, your goal is to provide the best possible care to your patients. But your patients may not see it that way when your office bills incorrectly.
This is a more common issue than you think–a whopping 30-40% of medical bills contain errors. It’s an annoyance for your patients and creates an obstacle to getting paid. If you’re looking to avoid medical billing errors, keep reading for our top 16 tips to simplify the process and bill accurately the first time.
1. Verify Patient Information
First, start with the basics: verify your patient information. If it seems hilariously basic, remember that mistakes can happen anywhere. Even in seemingly obvious places like a patient’s name, gender or birthdate. And even a mistake as small as misspelling a patient’s name can cause a claim to be denied.
If the patient isn’t the primary policyholder, you also need to double-check that the relationship between the patient and the policyholder is accurate. If required, check the group and policy numbers as well.
2. Verify Insurance Benefits
From there, you should make sure to check (and re-check) insurance benefits. In fact, the number one reason most medical billing claims are denied is because of failure to verify insurance coverage.
Remember, insurance information can change at any time, so it’s important to check and recheck insurance information–even if the patient was recently in for an appointment. Make sure to always check the patient’s insurance company, terms of service, coverage dates, benefits limit, and services covered under their policy.
3. Verify Every Medical Billing Claim Individually
While it may take a while (and be frustrating for your employees) it’s vital that you check (and recheck) medical billing claims individually before you submit them. Mistakes happen when you’re not paying attention, so make sure that every claim passes checks by at least two different people before it goes to the clearinghouse.
4. Use the Correct Medical Coding
Given the labyrinthine mess of medical coding, we can hardly blame you for making a coding mistake from time to time. Then again, upcoding and failure to enter the diagnostic code to the highest level are not conducive to getting paid.
Some of the most common medical coding mistakes include:
- Upcoding (when you meet with a patient for a few minutes but round up to the full 45-minute appointment)
- Unbundling (using multiple CPT codes for parts of a procedure when you could use a single code)
- Errors in appending code modifiers
- Overusing modifier 22
- Improper reporting of hydration and infusion codes
- Reporting unlisted codes without documentation
- Failure to check the National Correct Coding Initiative (NCCI) edits
One of the best ways to avoid this is to make sure your employees are up-to-date on the latest medical billing coding procedures–or to hire a service with trained and vetted coding professionals.
5. Understand Each Specialty
Of course, it’s not enough just to know your way around basic medical coding. Each specialty, from neurology to dermatology to cardiology, has its own specialized set of coding. Ideally, you should work with employees who have training in specialized medical coding or take the time to get your employees trained in this area. Failing that, hiring a service to help with specialized medical coding is an efficient way to solve the problem.
6. Implement a Practice Management System
Each year, US and UK companies lose a combined $37 billion annually to human error. The cost of intangibles, like customer trust, is even higher. The medical industry knows this all too well–an estimated 98,000 people per year die due to medical errors in hospitals. The best way to reduce the cost of human errors is to remove as much potential for human error as possible. You can do this by implementing a practice management system and automating as much of the process as you can. Go for a system that works for your practice. You don’t want a system built by solely by programmers–you want a system designed by physicians, for physicians.
That said, you can’t rely on a system to fix every problem for you. You still need to train your staff on how to use the system to keep up with demands and to develop skills within the system that set you up for success. This will allow smaller, budget-conscious practices to maximize efficiency and minimize error.
7. Failing That, Write Clearly
It’s an old joke that physicians have notoriously terrible handwriting–just ask any patient who’s tried to decipher a doctor’s signature. But the joke becomes decidedly less funny when you realize that atrocious handwriting remains a serious problem in medicine.
Once upon a time, doctors scribbled notes about a patient’s medical history that only they would read. Now, though, doctors share notes on a regular basis. And if they can’t read each other’s handwriting, you could be dealing with a whole host of problems (including inaccurate billing).
In-office jokes about a doctor’s terrible penmanship are one thing. They stop being funny when poor penmanship results in a rejected insurance claim. Get everyone in your practice to clean up their act–you’ll be amazed by how much easier medical billing becomes.
8. Make Sure You Haven’t Already Billed
Again, duplicate billing feels like such an everyday problem that you probably don’t pay attention to it. You’d know if you billed someone twice, right? You’d really think so…until your claim gets rejected because you already billed for a procedure. Before you submit a bill, check and recheck it to make sure you haven’t billed for the same procedure twice. If you’re not already using itemized bills, now is the time to start–they make it much easier to spot duplicate billing issues.
9. Monitor Changes in Healthcare Regulations
Staying up-to-date on the news and knowing all the latest changes in healthcare regulations are two very different things. The truth is, a coding or billing practice that worked last year may no longer meet regulations this year. You have to watch regulatory changes in Medicare, HIPAA, and other healthcare laws in order to ensure that your billing is accurate and legal. And if you don’t have enough time in a day to keep track of changes yourself, it may be wise to hire a billing service that does.
10. Stay Aware of Trends
You also have to stay on top of trends–in your billing errors, that is. If you pay attention to billing errors in your office, you may well notice a pattern. Errors may be cropping up in similar places. If that is the case, you can easily identify problem areas to review with your staff to avoid future mistakes. Ideally, this review should happen weekly. If one doctor doesn’t have time to check on billing every single week, try rotating the duty periodically to lessen the burden on each individual member of your practice.
11. Check for Out-of-Network Providers
Let’s say that Linda has a PPO plan and that she just had surgery. So long as she uses in-network providers, she only has to pay $250 for her deductible, which she has already met for the year. Here’s the problem: a few months later, Linda receives a bill for $4,000. Why? The anesthesiologist for her surgery was out of network.
Linda, of course, assumed that if the hospital and surgeon were in-network, the anesthesiologist must be as well. She makes some calls and finds out that the surgeon was not actually in-network either, and she’s on the hook for the surgical bill, as well. The fault for this lies with the healthcare provider, not the patient. Your job is to spot and prevent problems like this before they arise and to make sure that you’re billing correctly if you are in-network. Check and recheck information–before a patient has to pay thousands for a procedure that isn’t covered.
12. Make Sure You Billed for the Correct Procedure
Of course, you also have to make sure that you billed for the correct procedure. Let’s say an elderly man goes in for a regular check-up. He’s hale and healthy and goes home without a worry. But then he gets a bill for this check-up–including a charge for a pap smear, a test only performed on women. Some mistakes are embarrassingly obvious like this, but some are subtler, like billing for a procedure similar to the one that was performed. This comes down to a matter of communication and checks. A doctor should be crystal clear about what procedure was performed and how it should be billed, and you should have checks in place to ensure that the bill doesn’t leave your office with a line item for a procedure that didn’t happen.
13. Make Sure the Bill Went to the Right Place
Another common medical billing error is so basic it’s humiliating: sending a bill to the wrong insurance company altogether. This usually happens for one of two reasons:
- The person entering information doesn’t get a copy of the patient’s insurance card
- The person entering information simply isn’t paying attention
It’s understandable, especially in a busy office. But avoidable mistakes like this just make it harder for you to get paid. To dodge this embarrassing situation, make sure that you get a copy of the front and back of a patient’s insurance card, and make sure that your office staff knows how to find and select the correct insurance company in your internal practice management system.
14. Check Your Code Linkage
Code linkage is an essential component of your billing process, as it links your diagnosis code with your procedure code to demonstrate medical necessity (and without medical necessity, you’re not getting paid for a procedure). Basically, in order for code linkage to work, your diagnosis code and your procedure code have to match. This proves to the insurance company that your procedures were, in fact, medically necessary. Take a wild guess where your administrative staff might go wrong. To avoid this problem, make sure that your billing team understands how code linkage works and how to do it properly within your system. Before any bill leaves your office, make sure that the code linkage has been double-checked.
15. Establish a Clear Collections Process
If you want to guarantee the financial health of your practice, one of the best things you can do is clean up your collections process. Your staff should know each step in the process and what their responsibilities are throughout.
For example, you should:
- Establish clear terms
- Collect as much information about patients as possible
- Regularly verify eligibility
- Collect co-pays up front
- Immediately establish available payment options
If you don’t already, sit down with your team to develop a step-by-step breakdown of your collections process and what the expectations are at each stage.
16. Check, Check, and Check Again
If you’ve been paying attention, you can probably guess what our last (and most useful) piece of advice is. Check, check, and check again. Check every individual component of the bill, even if it seems glaringly obvious. You never know where a mistake might be hiding, and an insurance company will happily take an excuse not to pay. Alongside checking the bills, you should also be sure to check your staff’s processes. Make sure they are all trained in the most up-to-date processes and that they’re using these processes correctly. This will require ongoing training and a bit more manpower, but you’ll make up the cost by avoiding more expensive errors in the future.
Need Help in Reducing Medical Billing Errors?
As a healthcare professional, you’re doing everything you can to avoid medical billing errors. But sometimes, there’s only so much you can do without extra help. That’s why we’re proud to offer credentialing, coding, and consulting services with the highest degree of professionalism. We know how to check the pulse of your practice and help you drive results. Ready to see what we can do? Click here to get started. Or, if you have questions, don’t hesitate to get in touch.