Common Insurance Billing Mistakes

Most medical practice revenue is received by submitting “clean” claims successfully for insurance processing. Any mistake can cost you and your practice money. It is critical for a practices cash flow to minimize/eliminate those errors prior to submitting medical claims.

Let’s explore some common errors and how to avoid them:

Front Desk Mistakes

1. Verifying Insurance Eligibility – A patient’s insurance coverage can change at any time, (ID number, group number etc.) sometimes without the patient even knowing. A patients insurance can also be terminated for several reasons and at any time. Verifying insurance at each visit can help eliminate denials that would result from incorrect insurance information being entered and submitted.
2. Prior Authorizations – Some health insurance companies require a prior authorization to be obtained to cover certain procedures, services or medications. It’s important to get approval from the payer to cover specific services before the service is performed.
3. Patient Data Entry – Misspelling of a patients name or a typo in their insurance ID # can result in denials. Take the time to assure you’re entering the patient’s demographics correctly.

Clinician Mistakes

1. Coding Issues – Appropriate coding is essential. Here are examples of coding issues:
   1. Upcoding: This occurs when a provider or medical coder bills a health insurance payer using a CPT code for a service they didn’t provide, or at a higher level than what was performed.
   2. Undercoding: This occurs when a medical billing code does not adequately reflect the full extent of the service performed by the medical provider.
   3. Non-specific Diagnosis: Each diagnosis code should be coded to the highest level for the patients condition. Nonspecific diagnoses can result in denials.
2. Poor Documentation – If a healthcare provider documents insufficiently the result can be denied claims due to a “lack of medical necessity” by the insurance plan.

Billing Staff Mistakes

1. Duplicate Billing – This occurs when a procedure is billed multiple times. A good billing staff should monitor duplicate entries and communicate concerns with the provider.
2. Balance Billing – Per your agreements with insurance carriers, you should only bill patients for their copay, co-insurance and any other routine financial obligation per their insurance policy. Billing a patient over that amount allowed by your insurance contract can result in additional scrutiny by the carrier.
3. Timely Filing – All insurance carriers give providers a limited amount of time to submit a claim. It is important to know these filing time limits for each carrier. Submitting claims daily and to the correct carrier can help eliminate timely filing denials.

Many of the errors noted in this blog are simple and easily avoided. In order to do this, however, you must have qualified, detail oriented staff that take pride in their work.

Let us help you eliminate mistakes that are costing you money.  Consider using PSUSA to support your needs. Call us today and we’d be happy to answer your questions and/or set up a free practice consultation @ 800-599-7183 or email: info@physicianservicesusa.com.