Top Challenges in Medical Billing and Solutions to Common Errors

Medical Billing companies tend to have to deal with complex procedures. These procedures are important for the smooth running of their operations. The complexity begins from the minute a patient schedules his appointment. It becomes the company’s responsibility to maintain the record and keep it updated until its closure. Managing such procedures can be a tedious task which involves great experience.

Considering the importance of Medical Billing, not providing proper resources to it may lead to errors. Adopting such a system can bring with it certain issues that need to be tackled. In order to properly deal with claims, we must understand the difference between a denied and a rejected claim.

Denied Claim

This claim can be defined as the one that is labeled to be unpayable by an insurance company. There can be various reasons for such an occurrence. These reasons can be found in the Explanation of Benefits (EOBs) provided by the insurance companies. Usually, claims are denied due to billing errors or incomplete information. It is also dependent upon patient coverage. A claim of this nature can be appealed and reprocessed.

Rejected Claim

This takes place due to errors. In case medical billing personnel makes a mistake while noting down any information. This error can be in regard to both patient and insurance information which leads to rejection. The correction of these errors can lead to the resubmission of the claim for processing.

Challenges Faced

Medical billing specialists tend to make certain mistakes when they have a huge number of claims to file. Amongst the errors faced, we can mention the following:

Inability to access EOBs

Denied claims may not always come with EOBs which prove to be problematic. Without this attachment, the company would be unable to highlight the reason for denial. To make sure such a problem does not occur, you can stay updated when you receive the denied claims.

No Verification

Every patient with health insurance does not cater to the same needs. Especially considering that it changes with time. Therefore, it is vital for a medical billing company to confirm the insurance coverage of all the patients they treat. Without such verification, the claim may not be resolved as expected.

Doubling

Recording one service twice can lead to this problem. The bill is duplicated, leading to higher charges. It occurs if the service availed is reported twice or as such.

Upcoding

This is a concept where physicians or coders record the charges for a service that has not been availed. This is considered to be illegal as it is done to inflate the amount to be paid by the patient. Upcoding is considered to be a criminal offense that can lead to fines and prosecution.

Undercoding

The opposite of upcoding, undercoding is when charges are omitted from the patient bill. It means that the patient is not charged for all the treatment services they have received. It is also considered as an illegal practice, therefore, must be avoided. Undercoding takes place if the company wishes to avoid audits or minimize the costs of patients.

Bad Documentation

Documentation is quite important for the company on a whole. It is necessary for updated records. Therefore, laziness in documentation can lead to medical billing errors. This can take place if the handwriting of a physician is illegible. Bad handwriting makes it harder to derive and input the information correctly.

Other Common Errors:

  • Incorrect entries of the patient information
  • Incorrect entries of the insurance company
  • Incorrect codes by confusing the various codes involved. This includes mismatched codes.
  • Inputting the wrong amount of digits involved in certain codes
  • Failure to include all codes appropriately.

Solutions

It is vital for medical billing companies to emphasize the importance of accuracy in this process.  To ensure such accuracy, vigilance is of great importance. Therefore, one should be thorough about the documents and information they deal with. It is also possible to minimize errors from taking place by following certain tips. Amongst these tips are:

Coordination

Medical billing is not a one-person job. You require coordination with the various parties involved in the whole business. This majorly includes the physician and patient. With proper coordination, you can work through any issues that have a possibility of coming up.

Double-check

A very simple concept that can help you minimize mistakes. By contributing a little more time to the information, you can revise it and confirm its accuracy.

Keep Up With The Coding Trends

With time, the medical billing codes are bound to changes. In order to make sure you do not spend hours on end entering the wrong codes, you must stay updated. This occurs due to various modifications in the regulations, the discovery of new diseases and treatments. Therefore, a medical billing company should stay in touch with the possible trends taking place.

Follow Up

In order to avoid the common errors from occurring, following up on the claims can prove helpful. Through collaboration with an insurance company representative, you can learn about the mistakes and correct them easily. This means you will be able to resubmit the claims before they get denied.

These solutions may help you to decrease the number of errors that take place. It is important as medical billing errors can prove to be costly for the company. By keeping in mind these simple tips, such cost can be avoided and thus lead to effective use of resources.