4 Common Medical Billing Problems

The healthcare industry is only as strong as it’s billing procedures. Patients may dread the costs based on whatever health plan they’re on, but hospitals hang on every dime. Take away, or impair, that revenue stream and quality care becomes harder to attain.

Medical billing errors are the most common way health care finances are jeopardized. A lot of them are innocent mistakes. There might be bugs in the billing software, or the clerk using that program got one patients figures mixed up with another’s. Errors like these cost providers and patients over $1300! Listed below are some of the most common medical billing errors.

Upcoding

 A majority of medical billing service errors are coding related. Improper ICD-10 coding can cause overbilling that results in failed audits. Upcoding is a common manifestation of this problem.

Upcoding occurs when a patient is billed for more than the care they received. Let’s say a parent brought their child into the emergency room for a deep cut on their leg. They were admitted at 6 pm and released from the ER at 10 pm. When the parent gets the bill, they are shocked to find they’ve been charged an overnight stay plus an operating room fee. A charge like this should’ve been caught immediately or face serious legal repercussions.     

Unbundling

Another form of coding error is unbundling. Unbundling occurs when a single procedure is divided and billed separately under different cost areas. This too could result in overpayments, or incomplete payment.

These errors can be associated with the “superbill” system used by hospitals and medical services. Superbills tend to itemize procedure and diagnostic codes, time admitted, prescription quantities, and other factors. This process makes unbundling harder to spot. Inform the health care provider about this issue. Go over each item in the superbill and determine which falls under a given procedure coded into the bill by the office’s personnel.

Verifying Patient Insurance

An easy mistake is mixing up the patient’s insurance information. Not all patients are going to stick with the same insurance coverage for a long period of time. When they do change, it could cause a communication snarl.

Problems with verifying patient insurance can be avoided by a simple double-check. Follow up on claims filed with insurance companies. Contact the representative who handled the claim to find out if there were any errors. If there were, get the correct information so you can resubmit the claim.     

Claims Rejected

Providers might receive an Explanation of Benefits (EOB) from insurance companies concerning why coverage must be rejected. Rejections, however, are not the same as denials. EOBs are issued when patient or provider data is incorrect or insufficient.

Hiring a medical claims clearinghouse can help providers consolidate claims and administer them. Everytime a hospital submits a claim, a clearinghouse will examine the information for errors before passing it on to the insurer. Premium clearinghouses can handle batches of claims before they go out. This allows reimbursements to be settled in a matter of days.