Top 5 Medical Billing Errors: How They Hurt and What Can Be Done

Medical Bill

Medical billing errors are bad for patients and for your practice. The most common outcome is a denial of the claim by the patient’s insurance, sticking a patient with unreasonably high bills. This can lower the quality of patient care overall. When multiple billing errors result in many dissatisfied patients, it can hurt the reputation of your practice significantly.


Decreased quality of care and reputational damage are not the only issues you have to worry about because of errors in medical billing and collections. Regulatory agencies may perform an audit or launch an investigation of a practice that produces frequent billing errors. Your practice may face criminal charges of fraud if the audit uncovers sufficient evidence. Even if there are no charges, you may face significant financial penalties, and the investigation may cause further damage to your reputation.


Identifying the types of billing errors that are occurring in your practice can help you to determine the underlying cause. Whatever errors you are experiencing, chances are good that medical billing companies can help you solve them.


  1. Using a Manual Process of Claims Management


In this age of computerization and automation, it may seem incredible that anyone is still using manual claims management processes. However, an HIMSS Analytics survey in 2016 indicated that nearly one-third of all providers, 31%, still managed claim denials via a manual process. Not only is this considerably slower, but it also increases the likelihood of billing mistakes due to human error.


Medical billing companies not only take the process off-site, but automate it as well. In addition to helping to prevent errors, this streamlines the entire process, improving the patient experience while relieving a heavy burden from your staff.


  1. Sending Claims to the Wrong Insurance Company


This type of error is so basic that it is difficult to believe that it happens at all. When it does occur, it is usually either because the patient’s insurance has changed without your staff taking notice of it or because staff tried to submit the claim without getting a front-and-back photocopy of the patient’s insurance card.

Outsourcing to a medical billing company not only helps you make sure that the patient’s insurance information is accurate, but it also allows you to confirm immediately whether a particular service is covered, whether pre-authorization is required, whether the patient still needs to meet a deductible, etc. Having this information available automatically helps you offer the patient better care.


  1. Coding Inaccuracies


There are so many ways to enter a billing code incorrectly that it is no wonder that these are among the most common errors in medical billing and collections. A claim can be denied on the basis of a diagnosis code and procedure code that don’t match, or a seventh character applied incorrectly. Sometimes codes are added or omitted, upcoded or undercoded. Other times the codes are out of date.


A medical billing company has expert knowledge of coding procedures and regulations, constantly keeping up with updates or changes to them. Billing best practices and coding are areas of specialized knowledge for these companies. When you hire one to handle billing for your practice, all that experience and skill comes to bear in reducing billing errors due to coding.


  1. Collecting Information at the Front Desk


Inevitably, some billing errors occur at the point of contact between the patient and the staff. It is common for front desk personnel to make errors when collecting identifying information, such as the patient’s name. Transposition of digits in numerical data, such as date of birth or ID numbers, are also common mistakes.


Outsourcing to a medical billing company greatly reduces the demands on your in-house staff. Your front desk staff may be less likely to make errors and have more time to dedicate to their work and use time efficiently. Not only that, a less stressed front desk staff will allow them to improve patients’ experience by engaging with them more upon their arrival.


  1. Failing To Adequately Secure Patient Data


This issue is not confined to medical billing and collections. There are many ways in  which personal data from patient records can fall into unauthorized hands. Nevertheless, it is undeniable that there are many points during the authorization and claims submission process that a data breach can occur. You can clearly see how a medical billing company can help prevent each of these types of errors. Contact us today to learn how we can help streamline your medical billing process. 

Parul Garg, CEO and co-founder of PracticeForces, has significantly contributed to the growth of over 1,000 U.S. medical practices through her expertise in medical billing and coding since the company’s inception in 2003. With a background in Computer Science and an MBA in Human Resources, her leadership and AAPC-certified coding skills have been pivotal in managing the company’s operations effectively.

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