According to some estimates, up to 80% of medical bills have inaccuracies and healthcare fraud, including simple errors, costs $68 billion in the U.S. every year. Though we’ve moved toward better electronic records and technological solutions, there is a case to be made to outsource medical billing to healthcare organizations and practices.
The most common medical billing errors can cost the patient extra in charges. But they can also cost the provider in lost revenue and a longer wait time for reimbursement. If the medical error is deemed fraudulent, the practice may need to launch an investigation and an internal or external audit. Mishandling billing can also mean damage to the organization’s reputation.
For your organization, it’s important to have a plan in place to identify medical billing errors and correct them. Or better still, learn ways to prevent these errors from occurring in the first place.
The Most Common Medical Billing Errors in 2023
Medical billing and coding is complex and essential to the health of your organization. It’s important that you use best practices to ensure that you’re getting your medical billing right the first time. And one good step is to identify some of the more common medical billing errors that other practices have identified.
Here are a few to watch out for:
- Upcoding – For some specialties, you’re dealing with complex cases and that makes it more efficient to report a high level evaluation and management code. While that’s fine, you have to document exactly why the coding was used so that you’re not using a higher level code than is appropriate.
- Unbundling – This is when you use multiple codes for different parts of a procedure, rather than the appropriate code for the entire procedure. This can happen through error, but it also happens when organizations are trying to add to the payment amount, which is why it’s something that’s often audited.
- Not Documenting - Missing documentation or not documenting thoroughly enough.
- Typos and Errors - Sometimes you just hit the wrong keystroke. A common error happens when you invert numbers in coding or when information is added incorrectly, either by a staff member or a patient.
Recently, the AMA published a list of coding mistakes that can cost your practice, which is also worth a good look.
How to Prevent and Correct Medical Billing Errors
There are a number of steps you can put into place to guard against medical billing errors and help to catch them quickly when they happen.
Here are a few steps that your practice can put in place today:
- Learn best practice tips for medical billing - Make sure your billing staff stays up to date on new best practices and any changes to coding.
- Set a standard practice to verify patient information – Using a system that checks any new entry can help you flag when information doesn’t match previously gathered documentation. This gives you a second check to verify the information quickly.
- Set up a process to verify procedures in advance – Advanced verification is helpful at multiple levels. First, you verify the coding in advance. Second, the patient has better resources to budget for their healthcare costs.
- Proof check codes before submitting - Make sure that there are no errors in your coding, either by using a solution to run them through a clearinghouse or by checking them manually.
Investing in an cloud based EHR solution to manage these nuances can help save time and verify accuracy.
Consequences of Inaccurate Coding and Billing
There can be a range of consequences for inaccurate coding and billing. In worst case scenarios, the wrong coding entered into a patient’s information can result in significant risk for the patient – including the wrong diagnosis, treatment, and even procedures.
The financial consequences can range, as well. Inaccurate coding and billing can result in delayed payments, issues with reimbursements, and in some cases can result in an inability to collect payments for services. In the worst case scenarios, it can result in audits and even fines.
How PrognoCIS Can Help
PrognoCIS helps you avoid medical billing errors entirely with an electronic claims management process. With our EHR solution in place, your organization has access to one secure integrated solution to verify that your coding and billing is accurate.
A manual process leaves room for too many mistakes. With our electronic claims process, your organization can reduce costs and improve overall efficiency. Our clients find that they receive payments faster and the process is streamlined for a more productive workflow overall.
With PrognoCIS, you have access to a variety of reporting options to gain better insights into your billing and coding performance. You’ll be able to highlight denial trends so that you can adjust to meet provider requirements in a proactive way. You can also project the amount of time it takes for various providers to schedule reimbursements.
Our tracking features allow you to monitor claims at every stage of the process, for a holistic view of the practice, as well as an easy way to zone in on specific types of treatment and providers. You can also submit your claims electronically through our system to easily check for errors and submit at one portal.
- 80% of medical bills have inaccuracies
- Medical billing errors cost the US $68 billion annually
- Billing errors can cost the practice in lost revenue and longer wait time for reimbursement