Medical billing mistakes can be easily made, but have drastic repercussions on the overall profit of the healthcare organization. Returned claims with errors, denied claims, rejected bills, incorrect coding, and insufficient data are just a few of the many woes faced by medical billers. Almost 30% of medical bills are prone to medical billing errors. As common as these issues are, as complex as the system may be, the solution is at hand. As we sort through the commonality of medical coding errors and how to prevent them, how to correct medical billing errors, and steps in the medical billing process, there are certain areas that reveal a gaping hole. Improper medical billing can be mitigated by avoiding the error-prone areas and some common medical billing mistakes.
As medical billing and coding errors increase in frequency, patient experience is diminished, profits are adversely affected and the overall revenue cycle for healthcare is shunted. Efficiently adhering to the medical billing process and procedures can evade these outcomes through accurate claims management, offered through custom medical coding solutions. An automated medical billing solution may just be the answer to your healthcare billing and coding needs. Take your first step to eliminating billing errors by reading on.
The Essential Requirements for Medical Billing Management
Criticality of Medical Billing Systems – Medical billing processes are critical factors toward the financial health of the healthcare organization. Automated healthcare solutions are embedded with billing integration technologies exactly for this reason. With common medical billing mistakes, there is always a risk of losing a large sum of money. Finally, positive patient experience is directly proportional to the efficiency of the medical billing systems.
Excellence of Medical Coders – The medical claims process and common medical billing mistakes are usually a result of medical coder slip-ups. Whether a claim faces success or failure, therefore, lies in the hands of the medical coder. Needless to say, medical billing and coding errors can be considerably diminished with high-quality coders. Employing coders that are experienced, meticulous, and detail-centric lies at the key of success. It would be prudent to invest in regular training to keep up the quality of work.
Using Advanced Medical Billing Software – When systems are prone to human error, the wisest option is to deploy medical billing software, embedded with ICD-10 coding solutions and one that is HIPAA compliant. Additionally, medical claims management solutions can go a long way in eradicating the possibility of common medical billing mistakes. Healthcare billing solutions should be chosen carefully while keeping in mind the organization’s specific requirements.
Keeping Up With Changing Trends – Reducing the rate of denied claims and medical billing errors requires proficient medical billing management. This includes up-to-date medical credentialing and medical billing systems that are automatically updated with evolving codes and rules. The complexity of the medical claims process lies in keeping up with consistently changing codes and ICD-10-CM. Hospital management systems should be embedded with automated systems that track new and evolved codes.
5 Common Medical Billing Mistakes
Disorganised Claims Filing – Accurate coding lies at the heart of efficient claims filing in medical billing processes. Delayed claims filing creates untimely billing practices and is foremost among common medical billing mistakes. Deadlines are critically important in the claims filing process as it essentially decides whether the claim will be accepted or rejected. In the case of the latter, the organization’s cash flow is adversely affected and profits diminished. To avoid such a situation, the easiest option is an efficient system for billing and filing claims, through healthcare revenue cycle solutions. Tardy filing missed deadlines, and reduced cash flow possibilities are considerably reduced through automated systems.
Scattered Data Collection – Another trigger for medical billing errors is inaccurate and insufficient data collection and usage. Common medical billing mistakes occur when patient information is not collected comprehensively, and clinical procedures are not filed in a timely and accurate manner. Case management solutions can offer comprehensive data collection services for holistic data within a medical billing software. Improper medical billing can be drastically reduced when patient data is collected efficiently and used toward medical billing codes. Finally, accurate and complete data erased the possibilities of duplicate claims, which can further delay payment processing. Automated information filling, such as social security numbers, demographic codes, etc. can speed up the medical billing process and procedures.
Lack of Follow-Ups – Without a set system in place, follow-ups are lacking. When medical billers are not in the habit of consistently following up on outstanding payments, money hangs in the balance and cash flow is adversely affected. Problem claims remain unmonitored and negatively affect the bottom line. With custom healthcare solutions, follow up reminders can be set in place, which allow continuous claims checking. Regular analysis, aging reports on pending payments and overall billing integration through remittance software solutions are some ways to keep the follow up process flowing.
Disparate Systems – Medical care is an amalgamation of all services related to patient experience, administrative, clinical and financial. When healthcare providers deploy multiple and separate systems in the organization that are unable to function in tandem, the result is common medical billing mistakes. EHR should not be limited to use for administrative tasks and clinical processes, but much rather be integrated across the organization and even into the medical billing software. When medical billing services are able to pull out information from one common system or platform, the possibilities of improper medical billing are diminished significantly. Information collected right from the stage of appointment scheduling, up until the end point of bill generation keeps medical care functioning efficiently.
Incorrect Coding – Medical billing companies are faced with the constant irk of incorrect coding. The complex system of medical bills is owed to the complexity of accurate coding. Keeping up with updated codes, ensuring and double-checking the patient’s clinical processes to match the right codes is no ordinary task. Medical billing services, very often, face the issue of complacency. Codes are not double-checked for accuracy and old codes result in denied claims and reduced cash flow. Specialty billing solutions and automated coding software can greatly assist in mitigating medical billing errors. As medical billing companies attempt to streamline their medical billing services, coding accuracy should be established in the best way possible.
Billing Tips To Reduce Medical Billing Mistakes
Periodic Analysis – As with any other process, medical billing services can be improvised through regular analysis of strengths and weaknesses. Medical billing companies can establish a set format of automated analysis to keep medical billing errors at a minimum. Medical billing mistakes are usually the result of things slipping along a complex system. When these issues are periodically highlighted, the chances of rectification seem better. Whether it is inaccurate coding, untimely bill generation, information gaps, or clinical issues, the source of medical billing errors is easily identifiable through periodic analysis.
Cross-functionality – An automated software, operating on a common platform, to lend and receive information, is most likely to keep medical billing mistakes at the bare minimum. From patient registration, appointment scheduling, appointment reminders, administrative tasks, to clinical processes, pathology reports, and prescription requirements – all elements of the patient experience are significant toward billing. A holistic system that offers cross-functionality can mitigate medical billing mistakes to a large extent.
Data Sharing – An important component of the cross-functionality feature, mentioned above, is information sharing. When data used to schedule an appointment, or during a clinical process, can be accessed by the medical biller, there is a higher chance that coding errors will not take place. Furthermore, pathology and prescription data can lend toward avoiding medical billing mistakes, by offering a holistic picture of the services used by the patient. Even the preliminary provider and insurance information of the patient can be collected while scheduling an appointment, for added accuracy.
Automated Updates – Among the plethora of software and billing apps available, healthcare organizations must choose one that offers automatic updates of ICD-10-CM and HIPAA compliance. With codes changing fast, automatic code updating can go a long way in keeping medical billing mistakes at bay. Finally, patient information also needs to be periodically updated, which plays its part in keeping billing accurate. Incorporating automatic update provision within the software can ensure patient demographic information, clinical procedures, etc. are up-to-date.
Prior Authorization – Apart from coding errors, medical billing mistakes also result from inaccurate provider and insurance information. Verifying authorization information from the get-go prevents a lot of problems later in the process. Every small piece of information about the patient, including policy numbers, if gathered incorrectly, can cause a claim to be rejected or denied. Incorrect insurance coverage details is another significant contributor to medical billing mistakes. Patient eligibility verification is a key factor to maintaining billing accuracy.
Keeping in mind the above-mentioned points, it is most advisable to adopt an advanced medical billing software with automated features. This will ensure that medical billing mistakes, coding errors, incorrect information and cash flow delays are explicitly avoided. Medical bills are double-checked before being submitted to insurance carriers and there is no duplication of data entry required. Fewer denied and rejected claims, reduced workload for staff, fewer pending claims, increased overall profits, and higher patient satisfaction are all attainable factors, with the right kind of billing software.
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Written by Riken Shah linkedin
Riken's work motto is to help healthcare providers use technological advancements to make healthcare easily accessible to all stakeholders, from providers to patients. Under his leadership and guidance, OSP Labs has successfully developed over 600 customized software solutions for 200+ healthcare clients across continents.