Amidst escalating expenses, wage inflation, staff shortage, and the ongoing repercussions of the pandemic, healthcare providers may find themselves in a challenging predicament. It feels like the walls are closing in, and the final blow comes with an alarming surge in denial rates.

As per a CMS report, 48.3 million in-network claims (16.6%) faced denials in 2021. Unfortunately, the scenario persists, as highlighted by a survey by AKASA, which reveals that nearly half of the healthcare providers reported an overall increase in their claims denial rate in 2023.

Medical coding and billing may seem inherently complex, making it susceptible to errors. While you strive to achieve maximum reimbursement in your private practice, addressing and eliminating common medical errors becomes paramount.

Let's discuss the top medical billing errors that, once eradicated, can substantially boost your revenue and spare you from the vexations of the appeals process.

Top Medical Billing Errors and Ways to Eliminate Them

Errors in medical billing and coding frequently occur within medical practices.

While a significant portion of these errors stem from unintentional mistakes, a concerning number is intentional, driven by the desire to maximize financial gains. Regardless of the origin, fraudulent and abusive billing practices can erode trust in provider-patient and provider-payer relationships, result in penalties, and jeopardize the overall integrity of the healthcare system.

Here are 3 top medical billing errors you should avoid to maintain financial integrity, ensure accurate reimbursement, and preserve trust in healthcare provider-patient/payer relationships.

Neglecting Insurance Verification

Financial executives, including CFOs, in health systems and hospitals across the U.S. have reported that patient access/registration errors, such as eligibility issues or the absence of prior authorization, stand out as the primary reasons for claim denials.

Patient eligibility can change unexpectedly. Therefore, it's imperative to integrate a verification step into your billing workflow for each patient visit to confirm the coverage criteria.

Comprehensive eligibility verification must include checks for all 4 potential reasons for insurance-related denials:

1. Coverage termination or other ineligibility on the date of service.
2. Lack of authorization for the services.
3. Services falling outside the coverage scope of the plan.
4. Exhaustion of maximum benefits.

By implementing these diligent verification measures, we ensure that each procedure aligns with the patient's current eligibility status, reducing the risk of insurance-related denials and fostering a more robust billing process.

Overlooking Filing Deadlines

When it comes to medical billing, one aspect you really can't afford to overlook is meeting filing deadlines.

Different payers have varying "timely filing" windows, ranging from a generous two years to a tight 30 days. If you miss the deadline to file a claim, you're pretty much out of luck, especially since timely filing denials are a headache to appeal.

To make things smoother, maintain a handy list of filing deadlines for your most common payers. Make it a routine to check and double-check unfiled claims to ensure nothing slips through the cracks. And here's a tip – set up recurring reminders or calendar events. It might sound simple, but it's a super helpful way to avoid the headache of missing those filing deadlines. Stay on top of it, and you'll save yourself a lot of hassle down the road.

Wipe Out Billing Errors From Your Private Practice

Medical coding and billing errors are the unseen anchors that hold back the sail of progress in your medical practice. Beyond impacting your cash flow, these errors can incur penalties and tarnish your reputation within the healthcare industry.

Under the False Claims Act, providers can be held legally accountable for submitting claims to Medicare for medical services they know were not provided. This violation could result in a fine ranging from $5,000 to $10,000, plus three times the damages sustained by the Government. Therefore, diligence and accuracy in coding practices are imperative to ensure ethical and compliant healthcare billing.

Whether your practice is small or big, leave the hassles of medical billing and coding to Glenwood Systems. We leverage advanced technology (GlaceEMR and GlaceRCM) to seamlessly integrate patient eligibility verification with the billing software, ensuring accurate coding and billing while facilitating prompt submissions. This holistic approach streamlines the billing process, minimizes errors, optimizes reimbursement, and fortifies a robust foundation for financial stability.