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5 Most Common Errors in Medical Billing and Coding

October 26th, 2017 - By Matt Garnese

In case you missed it, here is the text version of a recent PrognoCIS Webinar, titled “5 Ways To Avoid Billing & Coding Errors.” In it, we discuss Revenue Cycle Management, and the best practices to avoid claims denials in medical billing and coding.

You can also view a recording of the webinar.

1: The Patient’s Insurance is Inactive or Termed

We find that this is the most common reason a doctor’s claim will allow for rejection. When performing treating a patient, you always want to check their availability at the time of service. Changes can occur with a patient’s insurance overnight, so you want to check their eligibility even if their insurance has gone through for prior visits. Electronic Health Records (EHR) software with integrated eligibility checking allows you to check a patient’s eligibility at the time of service, or perform batch checking before patient visits.

An additional note on eligibility: always use the patient’s full name. If the patient’s legal name is William, use that name as opposed to Bill, for example. To prevent immediate denial enter the patient’s full name correctly

2: Entering an Unsupported Diagnosis Code

Procedures have required diagnosis codes, and if you select the incorrect diagnosis code to get paid for that procedure, it will result in a denial. We recommend to our doctors to identify the Local Coverage Determination (LCD) and insurance guidelines for the top ten procedures performed in the office and create a “cheat sheet” for the medical staff. The “cheat sheet” template includes the procedure, each insurance company, and the diagnosis codes covered under those carriers. That way, you can quickly determine if the patient has coverage for a procedure before carrying it out. Many EHRs also provide templates to the practitioner for the procedure that allows you to keep a list of covered diagnosis codes.

Visit the CMS website for useful information on LCDs. Coding websites can also provide links to LCDs based on State/Area

3: Sending a Duplicate Claim Submission

Once you submit an initial claim to your insurance company or even your clearinghouse, that counts as the original submission. If you have to go back and fix something such as the insurance carrier, or subscriber ID, and resubmit without sending it as a corrected claim, it will reject it as a duplicate. It’s essential only to send the claim once, but if you must correct something, mark it as a corrected claim, and append the original ICN number to that claim.

Some practices assume that if a claim is unpaid within 21-30 days, then it has been rejected, and therefore must be resubmitted. Although received sometimes claims are not paid within the first 30 days. The correct course of action is to call the insurance company, or pull the claims up online and investigate further.

4: Bundling/Unbundling Medical Procedures

You can bundle several procedure codes together. Codes grouped for many different significant procedures, so make sure you identify them correctly. Check your coding book or coding website to see which procedures will bundle.

If you are conducting an office visit, and the office visit is the same day as surgery, you can unbundle it if the visit led to the decision for surgery. However, if the reason the patient came in originally was a procedure, then you don’t need to code for an office visit.

5: Coding a Claim With Missing Documentation

If you perform an X-ray in-office, you code for it, and neglect to create a separate procedure note, or even document that you performed it, you will receive a denial. Documentation and coding of claims for procedures done, if you have an RCM service that carefully scrubs your claims.

Revenue Cycle Management with PrognoCIS

Along with our EHR Software, we have integrated Practice Management and provide RCM services as well. PrognoCIS RCM services combine the EHR workflow with payment collections into a simple, single source that provides your practice with eligibility checking, processing of patient statements, customized scrubber checks, and a dedicated RCM client services manager.

To learn more about setting up PrognoCIS RCM services for your practice, contact our sales team at 1.877.693.6748, or visit our Medical Billing page below.


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