Claims denials, payment losses, and penalties tend to be triggered by medical billing and coding errors. It may negatively impact your relationship with your patients if you make frequent mistakes. Medical coding is an incredibly complex process, so errors are not shocking.
You may lose hundreds of thousands in revenue if you make simple medical billing and coding mistakes. When insurance companies or authorities reject your claims due to coding errors, you will lose repayment revenue until the documents are submitted again. The time is right to begin eliminating your coding errors, lowering rejections and denials, and maximizing reimbursements. Every aspect of your claim must be perfect for the repayment process to be smooth. We’ve compiled a list of medical billing and coding errors your organization could be making and the comprehensive steps you should take to avoid them.
10 Mistakes That Result In Mental Billing Claim Denials
Categories Are Too General
Diagnostic codes must adhere to the highest level (the maximum number of digits for the code entered). When ICD-9 first came out, the ICD-9 codes for essential hypertension were 401.0 (malignant), 401.1 (benign), or 401.9 (unspecified). In ICD-10, essential hypertension appears as I10. Essential (primary) hypertension in ICD-9, 401.0 includes high blood pressure and elevated blood pressure without an associated hypertension diagnosis. It appears as R03.0 in ICD-10.
A diabetes patient’s ICD-9 code is 250.0, which specifies the type of diabetes with the fifth digit. This code corresponds to E10.649 in ICD-10.
The Claim Is Incomplete
If any information is missing, there will be a denial, but the most common missing items are the time of the accident, date of emergency, and time of onset. Verify that all required fields have been submitted and attach all required supporting documentation.
The Deadline Has Passed
If a claim is submitted correctly but is not within the timeframe, the claim will fail. Healthcare providers should be aware that the Affordable Care Act reduced the Medical billing claim submission period from 15 – 27 months to 12 months. For Medicare claims, the start date is the “Service Date” or the “From” date on the claim form. CMS must receive the Medical billing claim before the end date (12 months after the start date). Medical billing claims received after the deadline will be rejected. Make sure you understand the necessary paperwork for reimbursement. If you are unaware of how to deal with the services denied timely. There is no payment. Commercial and Medical billing filing guidelines are different.
Incorrect Patient Identifier Information
To prevent this error, make sure the patient’s name and date of birth appear correctly. Verify that the payer and policy number are accurate as well. Also, you may want to verify that the claim requires a group number, that the patient is related to the insured, and that the diagnosis code corresponds to the procedure performed. If you have multiple insurances, make sure the primary insurance is listed first.
The claim could fail if you use an outdated codebook or when the coder or biller enters the wrong code. A coding system that is outdated either because of CPT (Current Procedural Terminology), ICD-9 (International Classification of Diseases), or HCPCS (Healthcare Common Procedure Coding System) or superbills will result in revenue loss. When a document is not available or inadequate to support payment of services billed, it is considered insufficient documentation. In coding and submitting claims, documentation must match billing. Carriers view the claims as not performed if they lack documentation. Denials relating to documentation and medical necessity are complicated because providers must take part in improving the process.
Submitting Incorrect Procedure Codes
If you press the wrong key, the system will enter a code entirely different from the intended one. Incorrect coding may also occur before arriving at the Medical billing departments. You may not be following the proper coding rules. If you are getting incorrectly coded claims repeatedly, it could be because your staff is not adhering to the correct coding rules. You can prevent errors by understanding precise coding.
Mental health Patients usually pay for more procedures than they need. Other times, patients receive bills for the care they did not receive. When that happens, there are tangles of issues to be untangled. Upcoding can occur if the medical billing department makes an error when entering treatment information or when the physician does not provide the billing department with precise details.
Errors in Healthcare Technology
The technology in the healthcare industry is fantastic, but it can also be complex. For mental health patients to receive quality care and an easy aftercare process, billing should be straightforward. Payment delays can result when telehealth services are misused, and no one wants to handle them.
Incorrectly Handled Payments
In some cases, the payer pays too much or too little, causing claims to fail to process correctly. Immediately rectify underpaid claims and treat underpayments equally. If interest payments are applicable, both parties should process them properly, and the provider must notify the payer if the payer does not follow the proper process.
Lack Of Information
The CPT Current Procedural Terminology cannot link correctly with diagnosis codes, resulting in delayed or denied claims. Coding errors are not always the problem. If a physician does not provide the correct diagnosis information, miscommunication can result. The importance of physicians providing the proper code at all times stems from this reason.
6 Mistakes to Avoid Medical Billing Errors
Medical practices need a steady stream of revenue to stay profitable and grow. The company also needs to ensure that medical billing errors don’t negatively impact the bottom line. We have provided six tips below to help you avoid medical insurance billing mistakes.
Make Sure You Stay Up To Date On Medical Billing Trendsmation
Billing codes continuously change due to the many changes in the healthcare sector and new illnesses and treatments coming to light. It is crucial to stay informed about new billing codes and procedures.
Avoid Double Billing
Ensuring that the Medical billing service provider does not get charged more than once is another way to avoid errors. Even though it may seem pretty self-evident, multiple people entering information make it easy for this to happen. Verifying each patient’s billing is extremely important to prevent future complications.
Watch Out For Inadvertent Coding Errors
The illegal practice of upcoding or under coding (which can result in fines and criminal prosecution) is sometimes intentionally performed to make money from service. A patient’s bill is upcoded with codes related to services received but not received-often to inflate the amount owed. An underscored invoice is one in which there are no codes in a bill – typically to prevent an audit.
Sometimes this occurs accidentally. Occasionally it is intentional. A lack of experience working with medical billing and coding typically results in a lack of efficiency, an overwhelming amount of claims, and a lack of updated knowledge about the industry.
Make Sure The Insurance Is Valid
Insurance problems are the main reason for denied claims. When a patient visits the office frequently, the staff assumes their insurance has not changed. You might be in trouble if it has changed and no one checks their eligibility.
Every time you ask for the patient’s insurance information, you confirm there are no problems with the policy, such as lapsed coverage, unapproved services, or services not covered by the insurance policy.
File Medical Claims Within The Designated Time Frame
Claims that fail to arrive by the due date cannot be changed. It is most difficult to appeal a timely filing denial.
Keeping a running list of the most frequently missed deadlines can help you avoid forgetting them in the future and make sure that your staff properly audits unfiled claims. You may also wish to consider setting up a recurring reminder or calendar event to resolve this issue.
Double-Check The Information You Have Entered
In the case of heavy involvement in billing and coding, it’s easy to make a general error, especially if you have other responsibilities. You should avoid these most common ones if possible:
- There was an error in transmitting information to insurance companies, patients, or providers (name, address, date of birth, policy numbers. Data entry errors occur.
- Leave code blank for a particular claim.
- Errors entering CPT codes.
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