Did you know that in 2010, Medicare inappropriately paid .
7 billion for claims for medical services that were either incorrectly coded or lacked proper documentation, according to the U.S. Department of Health and Human Services’ Office of Inspector General?
The accuracy of billing and claims processing is vitally important. Proper billing ensures patients are billed and that the doctor’s office gets paid for its services. If a billing system is inefficient, it risks the sustainability of the doctor’s office.
How to Avoid Medical Billing Errors
When clients are billed incorrectly, it can cause problems and make the doctor’s office appear incompetent. Here’s how to avoid medical billing errors.
First, put an efficient filing system in place. Hiring medical billing specialists to create a filing system will make certain that files can be found and that they stay secure.
Next, the doctor’s office should ensure that the staff is using accurate medical coding. Every procedure, treatment, and medication has a unique code, and making sure to use the right code will ultimately mean that the patient is billed properly, the insurance company claim is accurate, the doctor’s office is paid for its services, and they will avoid medical billing errors.
It is important for medical assistants and medical billing specialists to include enough data and documentation to support a claim. They should also check the details.
When processing billing, the medical billing specialist should double-check the patient’s personal details so the right patient is billed. The use of electronic medical records is changing the way medical billing is done.
No more doctors’ scribbling and office abbreviations. With electronic medical records, everyone can clearly see what codes are used and bill insurance properly, avoiding medical billing errors.
A training regimen should be implemented so everyone is on the same page and billing is done accurately the first time.
Finally, the medical biller should remember to not bill the patient twice or accidently upcode the claim.
Get an Efficient Filing System in Place
One of the first things a doctor’s office should do to avoid medical billing errors is put an efficient filing system in place. Medical billing specialists have the vocational skills and training to create an efficient filing system.
Ideally, an efficient office needs a billing system, organized filing, and accurate record keeping. As there are confidential client records in the office, patient information also needs to be secure to comply with HIPAA (privacy) guidelines. An efficient filing system is the first step in avoiding medical billing errors.
Ensure Accurate Medical Coding
Accurate medical coding is another way to avoid medical billing errors. The three main categories of codes are ICD, CPT, and HCPCS.
Medical codes are standardized denotations of diagnoses, procedures, medical services, and equipment. Medical coding is critical to getting bills paid on time.
Each diagnostic code relates to a specific disease, injury, or condition and is internationally recognized. National procedure codes are used to classify what has taken place and to ensure the patient is billed for the correct one. If an incorrect code is entered, the insurance company can reject the claim, disputing it as an unnecessary procedure.
Include Enough Data and Documentation
A common reason for medical claim rejection is the medical billing specialist’s failing to provide information to insurance companies to support the insurance claim. This type of medical billing error can cause denials and delays. The medical billing specialist must be proactive in identifying coding errors made by medical staff to process claims and accurately bill patients.
Check the Details
Checking the details is also a good way to avoid medical billing errors. It is important to check and double-check dates of birth, addresses, and other personal details before entering them in records. Errors occur when incorrect personal data is entered into the system, and this can lead to overcharging. It can also result in a bill’s being rejected by an insurance company.
A medical billing error leads to difficulties for the patient who is ultimately responsible for payment and for the doctor’s office which won’t properly be paid for its services.
Use Electronic Medical Records
Use of an electronic medical records system is a great way to avoid medical billing errors. The electronic medical record (EMR) is a systemized collection of a patient’s electronically stored health information. A variation of this, the electronic health record (EHR), can be shared by all providers in a patient’s care including physicians, medical offices, and health care professionals.
Standardized electronic record systems are more efficient and make clinical coding easier, as they are embedded. Errors on medical bills often occur due to handwritten notes and instructions that are unclear.
Electronic medical and health records save time, are more efficient, and are easier to keep confidential.
The use of electronic health records can also reduce the number of duplicate tests. With the help of electronic health records, each physician treating a patient will have insight into other physicians’ treatments. If a test has already been ordered, both physicians can share the results to offer better health care to the patient.
Implement a Training Program
To avoid medical billing errors, the medical staff should be trained properly with up-to-date instructions on how to operate the billing system and the procedures necessary to file insurance claims.
By understanding the importance of coding, the medical billing specialist will have the knowledge necessary to process accurate bills for the patient. The training program can be updated with new procedures. New employees will go through the training, and current employees will periodically get a refresher course.
Don’t Bill Twice
The medical office should have a robust audit system and filing procedures to avoid medical billing errors, such as billing a patient twice. Double-billing—and billing errors in general—make the medical office look inefficient and can cause problems with insurance claims. The medical billing specialist should establish an auditing process to prevent overbilling.
Another medical billing error that can occur is when patients are billed for a more complicated procedure than they actually received or for services that were never performed. This can happen because of inaccurate information from medical staff or as an error when the medical billing specialist enters codes into the system.
Creating an efficient filing system, mastering coding, including enough data and documentation, checking the personal details of a patient, using electronic medical and health records, implementing a training program, and not billing twice or upcoding are all vital steps to take to avoid medical billing errors.
Did learning about how to avoid medical billing errors interest you? Are you ready for a rewarding career as a medical billing and coding specialist?
The Medical Billing Specialist program at Hunter Business School on Long Island prepares billing and coding students to obtain entry-level employment specializing in medically related billing and coding in physicians’ offices, clinics, medical insurance companies, and hospitals. The Medical Billing Specialist program also offers students a diploma in three months of evening classes.