Are These 7 Medical Billing Issues Costing You Money?

Find and Fix These Common Mistakes Now to Stop Losing Revenue

To err is human. To forgive… is not insurance payers’ jobs!

At MDCodePro, we’ve noticed several medical billing issues that can hurt healthcare providers’ revenue.

We wouldn’t go so far as to call them the seven deadly sins of medical billing. But they’re definitely seven maddening mistakes when you’re trying—and failing—to get all the legitimate reimbursement you’ve earned.


Seven Common Medical Billing Mistakes You Must Avoid

Mistake #1 – Submitting Incorrect or Incomplete Information

A misspelled name. A wrong date of birth. An incorrect subscriber number. A missing date of service. Seemingly small mistakes can wreak big havoc on your revenue.

According to the AMA’s most recent National Health Insurer Report Card, almost a quarter (24.57%) of denied Medicare claims lacked needed information. This problem led the pack for several private insurers, too.

Why is it important to review claims prior to submission? Among other reasons, to catch any invalid or incomplete information before it renders claims unprocessable.

Mistake # 2 – Claiming Reimbursement When Patients Aren’t Eligible

Medical-Billing-Issues If they’re verifying patients’ eligibility, front-end staff can be your front line against rejected and denied claims.

Another 9.44% of denied Medicare claims fell short because the beneficiary’s plan didn’t cover the provided service, equipment, or drug. And patients using private insurers don’t always know their coverage as well as they think they do.

Medical Billing Group’s Stan Loskutov told Software Advice “a two-physician practice should spend 1-2 hours per day performing eligibility verification.” That’s time well spent when payers reject fewer claims.

Mistake # 3 – Failing to Discuss Patients’ Financial Responsibilities

More high-deductible health plans mean patients are shouldering more medical expenses—and not always successfully.

In 2017, patients’ out-of-pocket healthcare costs rose 11% on average, according to TransUnion Healthcare. No wonder one survey finds 85% of patients more concerned about medical costs than costs of retirement, college, housing or child care.

But only 23% of providers always discuss patients’ ability to afford services, reports technology and communications company West. More than a third (36%) never do.

If you’re not having candid financial conversations with patients, you risk taking more time to collect less revenue than you’ve earned.

Mistake # 4 – Billing Twice for the Same Procedures

Avoiding duplicate claims sounds like common sense advice, but because duplication happens so frequently, CMS has appealed to providers to stop doing it.

Duplicate claims can happen for many reasons. Some are outside your control—for example, another provider performs the same service on the same date and has already been paid for it.

More often, your organization must crack down on the bad billing practices creating this medical billing issue. Don’t automatically resubmit claims that haven’t been processed within 60 days, for instance, and don’t assume payments not yet posted haven’t been made.

Mistake # 5 – Relying Too Much on Manual Procedures

The U.S. healthcare industry has made “only modest progress” automating its transactions, the 2017 CAQH Index found. Providers seem reluctant to stop pushing paper around.

For example, about 77% send patients paper bills. And 31% manage denied claims manually, despite manual processes’ drain on internal resources and greater potential for human error.

Crunching CAQH’s numbers for HIT Consultant, Fred Pennic says a practice using electronic transactions stands to save up to 40 minutes and $15 per claim. So taking steps toward automated billing could add up to significant savings.

Mistake # 6 – Filing Your Claims Too Late

While Medicare allows up to a full year from the date of service for claim submission, other insurers’ windows don’t stay open as long.

Time limits of 60 or 90 days are typical; occasionally, an insurer allows a full four months (120 days). Deadlines can differ for in-network and out-of-network providers, as well as for physician practices and hospitals.

If your billing staff doesn’t keep track of the deadlines different payers observe, your organization will waste time filing claims destined for denial.

Mistake # 7 – Choosing the Wrong Medical Billing Codes

Medical coding is complicated. AMA Wire editor Kevin O’Reilly recently singled out eight different coding mistakes that cause providers trouble. His article—which includes such problems as unbundling bundled codes, omitting or misusing modifiers, and failing to check CMS’ National Correct Coding Initiative (NCCI) edits—drives home just how much room for coding errors in healthcare today actually exists.

Why is entering the correct codes important for billing? Because submitting the wrong ICD-10 or CPT® codes on your claims means you’re not giving insurers the complete picture they need to pay you what your work is worth.


Fix One Common Medical Billing Mistake Now with MDCodePro

Fortunately, of all the mistakes we’ve discussed, reversing the revenue-damaging impact of improper coding is one area where we can offer you an immediate and practical solution.

The MDCodePro app equips your practitioners with an easily remembered and quickly implemented method for making CMS’ daunting documentation guidelines a vital part of their daily work. Its video lecture series teaches the regulations’ basics in a streamlined, common sense way; and its code generator guides physicians, step by step, toward each visit’s optimal CPT® code, based on the newly strengthened documentation they input.

Audit after audit has verified and validated the MDCodePro approach, which has increased the annual revenue of the hundreds of doctors who’ve learned it by $30,000, on average.

Better documentation leads to better coding, and better coding leads to better revenue. You can resolve this costly medical billing issue right now. Sign up for your MDCodePro subscription today.


Leave a Comment