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7 most common medical billing errors that might result in claim denial

7 Most Common Medical Billing Errors

Those working in any medical billing company in Florida or anywhere in the USA are a part of a fast-paced environment where there has to be room for mistakes left. But, if we were to recognize the most common medical errors, these mistakes could be avoided, saving the office both time and money. That’s why professionals believe that reviewing the most common mistakes can help them be more aware and hence, improve.

1. Missing Information

If there is any missing information, it may become a cause for denial. The items that are usually found missing on applications are the date of onset, date of the accident, and date of a medical emergency. While providing medical billing services in Florida, you always have to make sure you scrutinize every claim for missed fields as well as the required supporting documentation.

2. If a Procedure is Canceled

If a procedure or a test ends up being canceled, then any claim filed by your biller will be denied. The responsibility falls upon the outsourced billing company to review every claim before sending it off to the insurance company.

3. Upcoding

Whether it is due to a clerical error or intentionally done by the biller, upcoding is the practice of showing a patient’s diagnosis more serious on paper than it actually is, so that the procedure covered by Medicare is a more expensive one, which when found out, results in claim denial.

4. Unbundling

A certified medical coder can relatively easily recognize an unbundling mistake, but even if you’re not, you should be careful not to separate charges that should actually have been billed under the same procedure code. To avoid mistakes such as these, those providing medical billing services in the USA should keep themselves updated on the National Correct Coding Initiative Announcements.

5. Wrongful/Duplicate Billing

A patient can not be billed for the same procedure, test, or treatment, more than once. If it happens, it’s considered duplicate billing and is grounds for claim reversal. Similarly, a procedure that has never been performed, if billed, comes under wrongful billing. It is also wrongful billing if a test was scheduled but later canceled, or treatment was wrongfully billed instead of the actual one. Even though most of these mistakes are the result of simple human errors, the medical facility in question can be fined for fraud for committing any of them.

6. Misunderstanding of an EOB (Explanation of Benefit) Form

Explanation of Benefits forms can be quite complicated. You need the experience to understand why a claim was denied, or exactly what was paid, or to determine whether a claim was paid correctly. An insurer might deny payment, or just pay a portion of a claim. If you find the payment arrived is less than anticipated, the careful reading of the EOB should determine the best strategy to resubmit the claim for the right amount. Doing nothing and just accepting the initial payment could prove to be a big financial mistake for the office. EHealthSource – The best medical billing company in the USA would always confirm whether or not the insurer sent the correct payment for all the codes.

7. Wrong Quantity

Always make sure that your patients don’t get charged extra for any wrong quantity of medications or other items. These errors by your medical billing department could be as small as placing an extra zero at the end of a number, but prove to be cause for claim denial!

Final Word

You have to first realize there is a problem before you can even begin to fix it. By learning the most common medical mistakes, you can be more cognizant of everything you do and take preventive measures to make sure those errors don’t occur in your office. You may even be able to strategize an action plan with your team to keep your office functioning more efficiently!

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