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Medical Billing Mistakes that Impact Healthcare Revenue

Rejected and Denied Claims Common medical billing mistakes lead to claims rejections and denials. But just because insurers reject a claim, this does not mean it has been denied. Rejected claims are often not processed because of incomplete or inaccurate patient data or insurance eligibility issues. Often, these claims will ultimately be accepted and paid if the applicable information is corrected and resubmitted to the insurance company. Accurate Information – Begin with the initial contact with the patient and gather information at the time of appointment-setting. Make sure all information is collected and entered correctly, including the patient's insurance and policy numbers, correct spelling of the patient’s full name, date of birth, gender as listed on their insurance information, primary policyholder name and social security number, and billing codes for any services provided to the patient. Eligibility Issues – Front-end staff must verify health insurance status and coverage. Eligibility issues are among the top reasons for claim rejections, and about 8% are rejected because of eligibility problems. Even if an insurance company ultimately determines a claim is not eligible for payment and denies it, the claim can be resubmitted and appealed if additional information can support its validity.

An estimated 49% to 80% of medical bills contain at least one error, and that equates to revenue loss. Every error increases the risk that claims will be denied, and denied claims cost time, money, and resources to correct. Accuracy is critical in every step of the billing process to avoid such loss. 

Common medical billing mistakes can wreak havoc on your bottom line and lead to frustration for you and your patients. Using a reliable clearinghouse is an optimal solution to help minimize human errors and other mistakes that lead to long revenue cycles and denied or rejected claims. By implementing an electronic system, common paperwork errors are avoided altogether. Electronic claim scrubbing will automatically check for errors before sending them to insurance companies, so they can be corrected quickly without the risk of causing a rejection or denial. 

Let’s look at how to prevent some common medical billing mistakes. 

Human Error 

The medical billing cycle is an intricate process that requires precision at every step. An administrative staff spends countless hours on the billing process, beginning the moment the patient walks through the door. Human error is a leading cause of delayed or denied claims because of training issues, inexperience, or simple paperwork mistakes. 

Lack of Training 

To avoid common medical billing mistakes, providers must offer continual training to all administrative employees, from front desk workers to billing specialists. 

  • Make sure medical billing software is continually updated, making regular training a necessity. 
  • Insurance information is ever-changing, so staff must stay up to date on ongoing policy updates. 
  • Misunderstanding the denial management process can result in rejected claims and an increased number of denials.  
  • All associates must understand the importance of the claim process. Front desk workers need to ask about insurance and address changes every time a patient signs in for an appointment rather than rely on potentially incomplete or inaccurate information.  Even simple flaws such as illegible handwriting and missed deadlines can be costly and delay payment. 

Lack of Experience 

Staff turnover leaves gaps to fill and inexperienced employees in a position to handle the complicated billing process. Bills and services are complex, so employees must understand how best to enter information, and providers are not always available for clarification. Having automation in place can prevent slowdowns caused by knowledge gaps and turnover.  

In smaller medical offices, providers are often responsible for billing which leaves them with less time to focus on their area of care and expertise. 

Posting Errors 

If charges are not posted on time and accurately, billing is delayed or incorrect. Effective claims processing involves posting payments from both patients and insurance. Unposted payments mean the balance due can’t be collected.

Code Errors 

Physicians and staff must be up to date on the latest coding rules, an enormous task to stay on top of. In fiscal year 2021, there were over 70,000 codes and almost 500 of them were new that year. Missing even one digit causes problems to occur. Diagnostic codes and treatment codes must match. Lack of data, upcoding, and telemedicine coding complicates the billing process. Medical billing software contains a predefined set of codes that assists providers in streamlining the collection of all the information to send to insurers. 

Rejected and Denied Claims 

Common medical billing mistakes lead to claims rejections and denials. But just because insurers reject a claim, this does not mean it has been denied. Rejected claims are often not processed because of incomplete or inaccurate patient data or insurance eligibility issues. Often, these claims will ultimately be accepted and paid if the applicable information is corrected and resubmitted to the insurance company. 

Accurate Information 

Begin with the initial contact with the patient and gather information at the time of appointment-setting. Make sure all information is collected and entered correctly, including the patient’s insurance and policy numbers, correct spelling of the patient’s full name, date of birth, gender as listed on their insurance information, primary policyholder name and social security number, and billing codes for any services provided to the patient.  

Eligibility Issues 

Front-end staff must verify health insurance status and coverage. Eligibility issues are among the top reasons for claim rejections, and about 8% are rejected because of eligibility problems. 

Even if an insurance company ultimately determines a claim is not eligible for payment and denies it, the claim can be resubmitted and appealed if additional information can support its validity. 

Maintaining a Long Revenue Cycle 

From the moment a patient schedules an appointment to when their account balance is finally fully paid, common medical billing mistakes lead to a longer revenue cycle and result in delayed or lost revenue. Every phase must be integrated and optimized for efficiency. Rejections and resubmissions are inefficient and cost providers valuable time and resources. 

Minimize Errors with a Medical Claims Clearinghouse 

A medical billing clearinghouse can help put the headaches caused by common medical billing mistakes in the past. Submitting clean claims is a key to prompt payment, and a reliable clearinghouse is a key to submitting clean claims. 

Claim processing software eases this burden, decreases paperwork, and helps multiple complex processes work together by: 

  • Simplifying coding and documentation with centralized and accessible data. 
  • Finding and correcting errors prior to submission. 
  • Processing claims electronically for accelerated reimbursement time. 
  • Uploading claims in batches and managing them from one location. 
  • Scanning for missing information. 
  • Analyzing reports to minimize denials.  
  • Decreasing lost income due to poor interoperability among all processing departments. 

Using technology to track claims, identify potential problems, and regulate the billing cycle creates a smoother overall process. Smoother translates to shorter with fewer roadblocks to overcome. Each healthcare organization generates mountains of electronic claims information that is susceptible to costly errors. Apex EDI claims processing software simplifies and streamlines every step of the process. Schedule a demo to learn how Apex EDI is the optimal solution for reducing common billing mistakes and optimizing the billing process. 

Schedule a Demo with Apex EDI's Insurance Claim Clearinghouse

Sources:
revcycleintelligence.com/news/4-medical-billing-issues-affecting-healthcare-revenue-cycle
www.all-things- medical-billing.com/healthcare- claim-processing.html
revcycleintelligence.com/news/examining-the- basics-of- the-health- care-revenue- cycle
revcycleintelligence.com/news/what-are- the-front- end-steps- of-revenue- cycle-management
revcycleintelligence.com/news/ahima-reviews- top-icd- 10-implementation- coding-challenges

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