If you are working as a medical biller, then it is very important for you to reduce medical billing and coding errors. Errors in your billing is the major cause of claim denials. Most of the error occurs when billers don’t comply with the guidelines provided by the insurance companies and government agencies. Sometimes claims marked as incomplete or invalid are due to the errors made by medical billers. Loss of revenue, delay of payments and costly fines mostly occurs if errors have not been caught and rectified ahead of submission.

Healthcare providers and physician practices earn majority of their revenue by successfully processing the payment claims, but if by chance medical errors are not corrected, it can cost the provider a huge portion of their income. To avoid financial difficulties, claim review and scrubbing is mandatory. Most of the claims are rejected by the medical insurance companies as errors had been made in those claims by the billing specialists.  They might have entered wrong insurance and patient’s details or due to any problem in coding.

There are main 7 types of most common medical billing errors that should be avoided:

  1. Balance Billing: This billing occurs when the policy holder of the insurance company receives a bill in which policy holder had to pay the left over balance to hospital or care provider after insurance companies had settled the arrangements with the hospital or care provider. In this scenario, policy holder should check with their insurance company in order to see if all of hospital’s charges had been covered under the policy, and if they are not, then this leftover balance is marked as illegal and the policy holder is under no obligation to pay that balance.
  2. Duplicate Billing: It occurs when the services or medication provided by the hospital or care provider are billed more than one time. For instance, nurses who are checking up on patients and the doctor who is responsible for their health, both specify that a certain medication was provided to the patient hence not knowing that it has been already billed on the very first call. So it can be a reason why patient’s medical bill provided is too high.
  3. Mismatched Treatment/Diagnosis Codes: It occurs when the biller has up coded your diagnosis leaving you treatment code singly, medical insurance company will fully decline the claim due to the mismatch between patient’s diagnosis code and treatment code. This is considered a serious medical billing error if it is overlooked or intentionally manipulated.
  4. Lack of Medical Necessity: It occurs when the care provider or hospital has been unsuccessful in providing the relevant information to the coder about patient’s diagnosis, then an incorrect code regarding the diagnosis is used in patient’s bill. Due to which, medical insurance company won’t accept patient’s claim marking it as “Lack of Medical Necessity” and patients will have to pay their care provider or hospital from their own pocket.
  5. Unbundling: It occurs when the charges levied on the patient by their care provider or hospital generally fall jointly under a one billing code but instead they are listed individually. And which can make patient’s bill a lot higher than the actual. So in order to avoid these types of mistakes medical billing companies should be consulted with to help you ensure that there aren’t any errors listed in patient’s bill.
  6. Incorrect Patient Information: It occurs if any misspelling error has been made in patients insurance ID or name which will result in declining of claim by the medical insurance company. This is a very common type of error as thousands of people claim for their insurance at a time. This problem should be dealt with as soon as possible as it can delay the payments and cause problems for patient in submitting their claim to medical insurance company.
  7. Up-coding: It occurs when a biller had changed the medical billing code from a small treatment to a very severe treatment and diagnosis. This is considered as an illegal method which can cause the patient’s bill to boost up. This usually happens when a care provider or hospital wants to earn through dirty ways in order to make more money and boost up their accounts.

In order to avoid these kinds of errors, professional medical billing companies should be consulted. Insurance benefits and eligibility of the services provided should be verified. Patient’s information should be thoroughly checked and reviewed. Diagnosis and procedure codes should be double-checked and scrubbed by a medical coding and billing experts. Ensure that billing hasn’t been already done for the services provided. All information should be provided clearly following the standard guidelines.

Cite this article as:
Editorial Staff, "7 Most Common Medical Billing Errors That Can Put You in Trouble during Audit," in Medicalopedia, August 2, 2019, [Permalink: https://www.medicalopedia.org/7650/7-most-common-medical-billing-errors-that-can-put-you-in-trouble-during-audit/].