How accurate are the claims submitted by your medical billing department? Given the complexities of the medical coding system, it’s not surprising that mistakes are made.
Unfortunately, even small errors can lead to claim denials and payment delays.
A March 2016 NBC News report noted an error rate of 7 percent to 75 percent in medical claims, depending on the source of the statistics. In 2010, the Office of the Inspector General reported that 42 percent of Medicare claims were improperly coded and 19 percent lacked sufficient documentation.
Whether the true error rate is closer to 7 or 75 percent, billing mistakes can have a big impact on your bottom line.
In addition to being costly for your hospital, these types of mistakes can also affect your relationship with patients. Avoiding common medical billing and coding mistakes will help reduce your error rate and keep your patients happy.
Here are five errors commonly made by hospital medical billers.
1. Not Enough Data
Failing to provide information to payers to support claims results in denials or delays. For instance, problems can occur if billing department employees don’t link a diagnosis code to the Current Procedural Terminology (CPT) or Healthcare Common Procedure Coding System (HCPCS) code or don’t add a fourth or fifth digit to the diagnosis code.
Although employee error causes some of these mistakes, they can also occur if physicians don’t provide accurate diagnosis information.
2. Upcoding
Upcoding occurs when patients are billed for more complicated procedures than they actually received or bills are submitted for services that were never performed.
Upcoding errors can occur if the billing department employee makes a mistake when entering diagnosis and treatment codes or if the employee is confused by the information provided by the physician.
3. Telemedicine Coding Errors
Healthcare technology makes providing quality care to patients in multiple locations much easier, but it also complicates the billing process.
Incorrect use of modifiers for telehealth services results in payment delays. For example, the GT modifier applies to real-time telehealth services provided by audio or video systems, while the GQ modifier covers services provided through asynchronous telecommunications systems, such as an emailed X-ray.
4. Missing or Incorrect Information
Errors or omissions are a common cause of claim denials and can be easily prevented by double-checking all fields before submitting a claim. Incorrect or missing patient names, addresses, birth dates, insurance information, sex, dates of treatment and onset can all cause problems.
Although it may not happen that often, sometimes information is accidentally entered in the wrong patient’s record. If billing employees only enter the information as provided and don’t investigate mismatches in treatments and diagnoses, a claim denial will follow. Unfortunately, in busy billing departments, these problems can be easily overlooked.
5. Incorrect Procedure Codes
A simple slip of the fingers can result in the incorrect entry of a procedure code. Information may also have been incorrectly documented on encounter forms or other supporting documentation.
If claims are frequently returned to your hospital due to incorrect procedure codes, your employees may not be following the latest coding rules.
To prevent reimbursement issues, hospitals must avoid medical billing and coding errors. Ongoing continuing education programs, as well as lunch-and-learns and other informal training sessions can help ensure that your employees are aware of the latest coding requirements and best practices.
Another way to improve your hospital’s efficiency is by using the right medical devices. To learn how to choose the most appropriate device for your organization, read our free eBook, The Hospital Administrator’s Handbook: Understanding Medical Device Approval.
