How to manage medical billing errors
March 01, 2022
Last updated on March 01, 2022
6 min read
5/5 (2 votes)

Even in the best of times, medical billing errors can be incredibly difficult to manage. For the patient, the frustration lies in lack of control and information about the situation; for the biller, it can become stressful to pinpoint where the error came from and how to go about fixing it. The longer you’ve worked in the medical billing business, the better you become at managing claim errors. Unfortunately, errors are unavoidable when it comes down to it. Cloud-based Medicaid billing software helps reduce the amount of errors you see, but eventually, an error or two will make its way into your world. Having a good understanding of where errors come from and how you can quickly correct them is the best way to stay on top of your billing. We highlighted the key parts of that process for you. 

Prioritize organization at your company

In almost every instance, proper organization can be the difference between quick problem solving and serious trouble. Once you’re alerted that you submitted a billing error, you should know exactly where to find the information needed to correct the situation. Every patient’s file should be stored in a secure location that is easily accessible for your team of billers. The best option for managing and storing claims is a system that automates the billing process and boosts efficiency. When you implement something like this at your business and have the ability to sort, organize, and find specific pieces of information at any time, it becomes much simpler to solve a problem as soon as it arises. 

Stay up to date on insurance policies 

Stay up to date on insurance policies 

Claim errors aren’t always due to a big oversight. In fact, most of the time a claim is rejected because of one small mistake. This can be as simple as forgetting a piece of information, like the patient’s age, or misentering one number in the patient’s insurance policy number. These situations are frustrating, but they’re also easily fixable. Dealing with various insurance companies can also be difficult—each company has different policies and requirements, which is why it’s so important to keep your internal records of that information up to date. To stay on top of things, periodically ask your insurance partners if you currently have their most up-to-date policies, and whether they’re planning on making any updates in the near future. Insurance companies are typically good at staying current and providing updates to their partners, but it’s never a bad idea to double check. 

Be cautious of incorrect coding 

There are tens of thousands of different medical codes available for use, so it goes without saying that at some point, you’re going to make a mistake. Submitting a code with one incorrect number is cause for rejection or denial. For instance, you might submit an incorrect bill for a fractured wrist and accidentally charge the patient for wrist surgery, which would obviously cost much more. When a mistake like this one is caught, it’s obvious that it was a true accident, but that’s not always the case. 

Never upcode or undercode

If you’re an experienced biller, you know that upcoding and undercoding are both highly illegal practices that come with a slew of repercussions if you’re found guilty. Upcoding is the process of coding for a more expensive service than what was provided in hopes of making more money, while undercoding is the opposite: coding for a less expensive service to save the patient money. If done intentionally, the coders and billers responsible could face serious charges. However, this is also something that could have been submitted by accident. The majority of the time, if a claim falls into the upcode or undercode categories, it was likely an unintentional error. Still, it’s something to watch out for during the billing and coding process. 

Avoid duplicate billing 

Avoid duplicate billing 

Duplicate billing occurs when a patient is billed multiple times for a service that they only received once. This error is almost instantly a reason for denial, since it’s unlikely that a service was truly received twice. Duplicate billing is a common error that can typically be resolved in a few days to a week, however, it could still hurt your business’s reputation, especially if it occurs repeatedly. When it comes time to hit submit, make sure you’re only sending over one claim per service. 

Verify insurance coverage ahead of time 

One of the simplest and most efficient ways to avoid billing errors is by verifying a patient’s insurance coverage before the appointment begins. This process is as simple as asking a patient to fill out or confirm that none of their information has changed before the appointment begins. This may feel like a hassle for the patient, and maybe even for your front-end staff, but in the end, it’s well worth it to verify this information up front and avoid the hassle of error-filled claims later on. 

Invest in reliable billing software 

Billing software isn’t magic, but it definitely solves a handful of the problems you run into during the billing process. Billing software is designed to automate and optimize your billing from beginning to end. This means from the second the patient walks in the door, to the moment you press “submit claim,” your billing system is collecting, organizing, and simplifying the information needed to ultimately create a claim. Billing software can’t guarantee that you’ll submit every claim error free for the rest of your career, but it most definitely reduces the amount of rejected and denied claims you see. If you’re ready to say goodbye to a tedious, manual billing process, the team at BillPro is happy to help you make the switch. Sign up for your free demo today to see how our NY Medicaid billing software can take your business to new heights. 

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