Some Common Mistakes in Medical Billing and How to Avoid Them

As a healthcare specialist, when you are navigating through the complex world of medical billing, it is often exhausting. It doesn’t matter if the bill is from a surgical center or a regular hospital. There are several challenges that must be encountered. This is because they can directly impact the revenue and shape patients’ perceptions of their healthcare journey.  

When you get deep down into the complexities of medical billing services, it becomes clear that there are errors in the process. Any kind of mistake, no matter how small it is, can result in denials, revenue loss, fines, penalties, and affect patient care. Once it becomes clear that how to prevent medical billing and coding errors, the claim denials can be minimized, payments are increased, and patients are satisfied.

Healthcare facilities of all sizes need advanced medical billing services like Eminence RCM. To manage your medical billing process smoothly & your provider must continuously strive to strike a balance in your revenue cycle.  

In this blog, we will understand the entire medical billing procedure, the mistakes in the entire procedure, and how these mistakes can be avoided by getting the right medical billing services.

What is Medical Billing and Coding? 

Medical billing refers to creating healthcare claims that are sent to insurance companies. The aim is to secure payment for medical services provided by healthcare providers and organizations. Once a healthcare service is converted into a billing claim, the medical biller tracks the claim. This is to ensure that the organization receives compensation for the services rendered by the provider. A skilled medical biller can enhance revenue performance for healthcare practice.

The overall process of medical billing is quite complex and exhausting. However, when you are familiar with all the concepts and processes, it becomes easy to tackle the challenges.  

The Steps in a Medical Billing Process 

The key to a smooth medical billing process is establishing consistent workflows. This is helpful to consistently handle claims and reimbursements. Let’s learn how the medical billing process works: 

Record Patient’s Information 

As soon as the patient enters your healthcare practice for the first time, he is asked questions regarding his age, health insurance, and other important background information. The foremost step is to gather all the patient information carefully.
You must be quite vigilant while entering the information and make sure to re-confirm every piece of information that you enter in your medical records.  

Creation of Superbills 

When a patient repeatedly visits the healthcare facility, the information that is on record must be updated. After that, the medical coder will take all the information and transform it into diagnosis and procedure codes. The process is initiated after the patient checks-out.

The information includes: 

• Data of healthcare provider and clinician  
• Demographics and medical history of a patient 
• Different procedures and services  
• Various diagnosis and procedure codes 

Generating and Filing Claims 

In this medical billing process, another important step is to generate a claim. Then the superbill is utilized to prepare a medical claim and carefully submit it to a provider. After the bill is generated, it must be ensured that your claim meets all standards, rules, and regulations. During sending the claim, you can send it electronically to a clearinghouse. It helps the insurance providers and healthcare providers to communicate with each other. Remember the fact that there are insurance providers like – Medicaid that accept claims directly from the healthcare providers.  

 Following Up on the Payment 

Once the claim is approved, you are ready to get paid by the payer. You must understand that it can take a lot of time between getting a claim approved and receiving payments. If your AR is perfectly managed by the medical billing services you choose, you’ll get regular updates on your overdue claims. Make sure you get in touch with the claims before you get paid.  

Common Mistakes in Medical Billing Process 

Errors in Patient Information 

Although it is obvious that it is fundamental to ensure correct patient information if you want smooth billing operations in your healthcare practice. However, the sad reality is that there are several errors in patient information which costs a lot for healthcare providers. The various examples include – incorrect addresses, misspellings, wrong date of birth, etc. 

Cases of Upcoding and Unbundling

Another scope of mistake arises in upcoding and unbundling. Most of the time, these errors are accidental but can be a very common source of insurance fraud.  
Upcoding and unbundling contribute to billions of dollars in fraudulent claims each year in the United States. It leads to higher healthcare costs and increased insurance premiums. To overcome these losses, insurance companies raise their rates and invest in staff to investigate and prevent such practices. 

Improper Documentation 

There are times when claims are denied because of inadequate documentation. This results in failed reimbursements for the medical procedures. You will see lapses in documentation. It includes inadequate recording of the complaint, test results from in-office procedures, or associated diagnoses during the encounter. 

Insufficient documentation also occurs when there is a mismatch between the diagnosis code and the procedure code submitted on the medical insurance claim. It can also happen when the diagnosis code fails to justify the procedure code. Establishing the proper link between diagnostic and procedure codes is important for accurate coding and billing, ensuring timely reimbursement of claims. 

How to Overcome Mistakes in Medical Billing Process  

Keep Patient’s Information Updated  

The journey towards clean claims starts with ensuring accuracy in your medical claims. Make sure your healthcare practice verifies the insurance information regularly. Take care that your facility doesn’t risk AR days in denials. All the processes must be in place to verify insurance coverage, eligibility, and authorizations needed before check-in. Insurance payers can also deny claims if there are minor errors in information of patients. Therefore, patients should also verify their demographic information.

Proper Coding and Documentation  

To get clean claims, your medical billing services provider must begin with precise coding and detailed documentation. However, there are times when healthcare providers face time issues during office visits. It includes challenges with electronic health records (EHR), which is a common contributor to physician burnout. With overwhelmed providers, there's a risk of overlooking necessary codes or supporting documentation. 
Get medical billing services from a reliable partner like Eminence RCM, that ensures proper coding and documentation in your billing process.

Properly Track and Resubmit Denials  
There is an estimate which suggests that almost 5 percent of all claims face denial, with 50% of those denials left unaddressed. Managing denials and ensuring clean claim resubmissions can be really demanding. When the denial rate goes up, it can potentially result in substantial revenue loss for your healthcare practice.

To tackle claim denials effectively, you can start by examining what are the prevalent reasons behind them. For instance, if the major reason for your practice's denials is missing documentation, consider implementing provider training and support. Alternatively, if inaccurate patient information accounts for a significant portion of denials, refining your check-in process becomes quite necessary. 

Eminence RCM can help your practice get paid more and faster. Get simplified workflows and smooth payments and save your healthcare facility’s time and money.