While there’s no way to prevent 100 percent of mistakes in medical billing, healthcare organizations can still take some precautions to reduce the chances of a costly error.
In a previous article, we explored a few of the most common medical billing and coding issues. In this post, we’ll discuss how to identify potential risks of medical billing issues, how to resolve issues quickly when they do occur, and how to prevent the errors from happening again.
Emphasize the Importance of Quality Assurance
Many claims are rejected due to simple data entry errors. Misspellings of patient names, the wrong birth dates or incorrect procedure codes are all common mistakes medical billers make and can be avoided by emphasizing the need to proofread claims before hitting the submit button. Taking a few minutes to verify the information is entered correctly is one of the simplest ways to reduce mistakes.
Unfortunately, if billers feel pressured to reach quotas, they may be reluctant to spend much time proofreading. If your organization has quotas and billers frequently make simple mistakes, it may be worthwhile to reevaluate the quota system and make adjustments.
Use Daily or Weekly Reports to Spot Trends
Some medical billing issues may be anomalies, but it’s more likely your hospital will repeatedly run into similar errors.
Medical billing software makes it easy to spot and categorize billing errors by allowing staff to run weekly or daily reports and set up alerts. After staff members identify possible trends, doing a little detective work can help uncover the reason behind the mistakes.
For example, if claims for a particular type of procedure are suddenly being rejected or denied, it may mean medical coders aren’t using the most-up-to-date codes, which leads to billers inputting the wrong codes. An upswing in claims or denials from a particular insurer can mean the insurer has changed reporting requirements or modified coverages. The good news is these issues often can be resolved with a quick phone call or a retraining session.
Make Sure the Hospital’s Billing Software Is Current and Easy to Use
Although medical billing software has made the billing process much simpler, outdated software can hinder the organization’s billing efforts—particularly if it’s not updated with the latest ICD codes and billing requirements. Only invest in software that offers real-time or near real-time updates when codes or requirements change.
Most importantly, don’t neglect the user-friendliness of the platform. The most highly recommended software program won’t be very effective if it’s too difficult to use.
Stress the Importance of Ongoing Training
Regular training programs help ensure your hospital’s billers understand how to avoid common medical billing issues and have the skills needed to work with complicated claims. When requirements change, sending an email to billers offers a simple way to spread the news, but it may not be the most effective way to communicate exactly how to adjust to the new requirements. A brief training session can clear up any misunderstandings, reduce mistakes and give leaders the chance to emphasize best practices.
Offering training programs for providers and others who handle patient information can also help reduce rejection and denial rates. Employees who are not directly involved in the billing process may not know they still play an important role in filing claims. Invite them to participate in some basic training sessions so they can also stay on top of any changes to the billing process.
Decreasing medical billing issues not only reduces reimbursement delays but also helps improve employee satisfaction. When employees have the tools and training they need to excel, your organization will likely see an increase in productivity and an increase in employee morale.
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