Patient care can get complicated, especially when you’re juggling multiple health issues that require a variety of services. This complexity doesn’t just stop with treatment; it also extends into the nitty-gritty of coding and billing for all those detailed services. 

As a healthcare provider, you aim to secure full reimbursement for the time, effort, and expertise you put into caring for your patients. On the other hand, insurance companies focus on ensuring that the services billed are justified and appropriate. Errors in your claims can raise doubts about the legitimacy of the services delivered, leading to claim rejections or delayed payments. 

Understanding and avoiding common medical coding and billing errors is pivotal in maintaining a smooth revenue cycle and ensuring that your practice is compensated fairly for the services rendered. Let’s uncover the best practices for avoiding medical billing errors and securing full reimbursement for your services.

How to Avoid Common Medical Billing Errors?

Claim denials are on the rise. In fact, a recent MGMA poll revealed that 89% of medical groups reported that claim denials are either higher or the same this year compared to the previous year. This rise in denials can significantly impact your financial stability and obstruct smooth practice operations. To mitigate these challenges, we must identify and address common medical billing errors leading to claim rejections. Here’s how:

1. Double-Check Patient Information

One might assume that entering patient details when submitting claims is pretty straightforward, yet it remains one of the most common avoidable errors. Errors in patient information can arise due to mismatch, incorrect, or missing information. Medical billers must record accurate demographic information, which includes the patient’s name, address, date of birth, and insurance ID. Even a small typo can lead to a claim denial, for example:

• Misspelled names
• Incorrect addresses
• Missing dates of birth
• Errors in insurance ID numbers
• Invalid or outdated contact information

‎Double-checking each patient detail before submitting a claim reduces rejections and ensures timely reimbursement.

2. Conduct Insurance Verification in Advance

Insurance coverage varies with health plan, modifications in payer policies, or if the patient switches to a new payer or health plan. Administrative staff often rely on the existing insurance details provided by patients, especially for regular patients, leading to errors in eligibility.

To mitigate the risk of error in insurance coverage and provide patients with an accurate estimate of their financial obligations, the administrative staff should conduct eligibility checks during the appointment scheduling process and again on the day of the visit.

Here are some key steps for robust insurance verification:

• Ensure the patient’s coverage is active when scheduling the appointment.
• Verify the prior authorization requirement.
• Inform patients about their coverage criteria and any potential out-of-pocket expenses (deductibles, coinsurance, and co-payments) they might incur.
• Reconfirm the patient’s insurance status during the appointment to catch any recent changes in coverage.

3. Eliminate Duplicate Billing

Duplicate billing happens when a healthcare provider files a claim multiple times for the same service or procedure rendered to a patient. Approximately 30% of errors in medical billing are due to duplicate billing.

Duplicate billing can arise due to miscommunication between departments or staff members, overlapping roles and responsibilities resulting in repeated entries, or inadequate integration between electronic health records (EHR) and billing systems. Beyond leading to claim denials, duplicate billing can result in penalties, damage the provider’s reputation, and strain the provider-payer relationship.

Conduct rigorous audits to flag duplicates. If you detect a duplicate, promptly notify the patient’s insurance company to avoid professional and legal issues. Regularly review and update audit procedures to ensure compliance.

4. Employ Strategies to Prevent Upcoding

Upcoding and unbundling are manual errors that can lead to significant legal and financial repercussions. Upcoding occurs when you bill a medical service at a higher rate than the original service provided. Unbundling involves breaking up a procedure into individual components and billing for each one separately rather than using a single comprehensive medical code. These errors can be accidental or intentional — either way, they are considered fraudulent behavior. Here’s how to avoid them:

• Adhere to Accurate Documentation — Ensure the charges align with the clinical documentation.
• Understand Bundling Rules — Follow the bundling rules and comply with updated guidelines.
• Conduct Regular Audits — Audits help catch discrepancies. Perform routine checks on billing practices to ensure accuracy and compliance.

5. Stay Current with Coding Standards

Medical billing codes undergo frequent additions, revisions, and deletions. For example, in 2024 alone, 395 new codes have been added. Staying current with these changes can be challenging but is crucial for ensuring accuracy and avoiding denials. Prioritizing continuous training and staying informed about coding updates will help your team adhere to the latest standards.

6. Prioritize Ongoing Training

Medical billing is a dynamic landscape driven by ongoing regulatory modifications in Medicare, Medicaid, and private insurance billing. Outdated practices are unacceptable in this rapidly evolving environment. Healthcare professionals must rigorously adhere to the latest ICD, CPT, and HCPCS codes.

While 89% of healthcare organizations struggle with claim denials, 11% could effectively reduce denials with enhanced staff training. Regular training sessions are, therefore, indispensable. Additionally, encourage your team to:

• Attend Workshops and Training Sessions — Participate in training sessions and workshops offered by coding organizations.
• Subscribe to Coding Newsletters — Regularly read updates from reliable sources like the Centers for Medicare & Medicaid Services (CMS) to stay informed about changes in coding standards.

7. Leverage Technology to Minimize Errors

Medical billing errors often stem from manual processes. Embracing technology streamlines the billing process, enhancing accuracy and efficiency. Implement the following technological solutions to reduce billing errors and optimize claim submission:

• Electronic Health Records (EHRs) — Integral to maintaining precise and current patient records. EHRs minimize the need for repetitive data entry, thereby mitigating billing inaccuracies.
• Automated Transcription — AI-driven transcription tools like GlaceScribe convert provider-patient interactions into text, ensuring comprehensive documentation while alleviating administrative burdens.
• Billing Software — Investing in robust billing software with advanced claim scrubbing features to detect potential errors before claim submission, improves accuracy and streamlines the billing workflow.
• Predictive AI — Utilize predictive AI to identify denial patterns and recommend proactive measures to mitigate errors, ultimately enhancing financial performance.

8. Partner with Medical Billing Specialists

Healthcare professionals are experts in patient care but may sometimes lack medical billing and coding skills, making the billing process cumbersome. A medical billing specialist can alleviate this burden, offering an extra layer of accuracy and expertise.

Partnering with a professional medical billing service ensures on-time clean claim submission and compliance. They are experts in revenue cycle management and have the resources and specialized knowledge to effectively handle complex billing issues, decreasing denials and revenue loss.

Glenwood has empowered several private practices to optimize their medical billing, elevating their financial performance while alleviating their burden. Our advanced practice management software tools — GlaceEMR, GlaceRCM, and GlaceScribe — ensure your practice submits clean claims and maximizes collections. Moreover, we implement a robust denial management strategy that tracks every denied claim until it’s settled, safeguarding every dollar you own.

Effortless Financial Boost

Medical billing requires meticulous attention to accuracy and compliance. Adopting best practices in billing can effectively prevent errors and safeguard your revenue. However, as a physician, your expertise lies in patient care, and the demanding billing process can take time away from your primary responsibilities. Entrusting billing tasks to experts allows you to focus on delivering exceptional patient care. This partnership guarantees compliance and optimizes the revenue cycle, allowing your medical practice to thrive.

Considering partnering with a billing expert? Feel free to reach out to us for any assistance. We’re here to help streamline your billing processes, avoid errors, and enhance your practice’s financial health.