Part of what will determine the success of your medical practice is the ability to generate a reliable and predictable cash flow. To do this, you need to have confidence in your medical billing and coding procedures.
Incorrect billing and coding lead to a higher rate of denied claims, loss of time and productivity, and a loss in revenue. It can even lead to legal troubles if the problems get serious enough.
To help you prevent issues with billing and coding, let’s examine some of the most common errors and what you can do to avoid them:
- Incorrect Procedure CodesThe most common and straightforward issue is using incorrect procedure codes. Whether caused by incomplete or incorrect documentation or an unfamiliarity with the coding system, the result will likely be a rejected or disputed claim. This will end in a delayed payment or other problems.Solution: To correct this issue, institute a process of documentation review to eliminate as many errors as possible. Stay up to date with changes or updates to the medical coding system. Relay those changes to whoever needs to understand those changes.
- Missing or Incorrect InformationAnother common issue is missing or incorrect information. This can be a result of changes in address or phone number or the incorrect entry of information such as name, date of birth, or insurance details.Solution: Develop procedures that require multiple checks or reviews conducted by different people. Also, ask patients to review their information to ensure that their basic details have been recorded properly. It may also be necessary to do periodic checks to ensure a patient has changed their phone number or moved to a different address.
- Upcoding/UndercodingUpcoding and undercoding errors are a subset of incorrect procedure codes, but are worth examining because of their specific nature.Unlike upcoding errors, which occur when a patient is billed for a more complicated procedure or for a procedure they never received, undercoding errors happen when your patient is not billed enough. Both types of errors can have a serious impact on your practice, including negative impacts to your cash flow as well as suspicions of fraud (even if errors are honest mistakes).Either type of error is sloppy and does not reflect well on your practice.Solution: To prevent these types of errors, ensure that you have a communication plan that allows for people to ask questions when needed and to communicate important changes to the medical coding system. Also, do periodic reviews and spot checks so you can ensure the proper codes are being used.
- Telemedicine CodingDue to the pandemic and the rise of telemedicine, this type of coding error has gained more attention. Telemedicine was a forced change in a truncated, high-stress period of time. It is also a fairly new technology, especially for older patients. Given everything that has occured over the past year, mistakes should be expected.Solution: As we have written before, telemedicine is here to stay. To ease the transition, update your internal procedures to account for the changes in workflow for telemedicine. Additionally, make sure communication channels are open so that everyone on your team is on the same page.
- Duplicate BillingAnother common issue that appears to have a simple fix is duplicate billing. This occurs when a patient gets billed multiple times for the same procedure. Most often this occurs when you have multiple people handle the billing or when someone fails to note that a patient has already been billed.Solution: The solution for this is fairly straightforward—assign one person to do billing. If your practice is busy enough that you need more than one billing person, institute a policy of checking when a patient was billed or a claim submitted.
- Insurance IssuesIssues with insurance are another common problem when it comes to coding and billing. A patient’s insurance may have lapsed or they changed insurance policies or providers. Additionally, their insurance information could have been entered into your system improperly, whether due to internal error or incorrect information given by the patient. In any case, issues with insurance will almost always delay payment in one way or another.Solution: The best way to avoid these types of problems is to verify your patients’ insurance at every visit.
The medical coding system is complex and forever evolving, so it is understandable that errors will happen from time to time. However, by identifying which errors are most likely to occur and creating safeguards against them, you can minimize the occurrence and impact.
Another solution that we did not mention yet is to outsource your medical billing and coding. Your practice specializes in taking care of your patients. A business that focuses on medical billing and coding, like Mednet, specializes in ensuring clients get paid for the services they perform. If you are interested in learning more about how Mednet can take the stress out of billing and coding and help you increase your revenue, please contact us today.