Top Challenges in Medical Billing and Solutions to Common Errors

In medical billing, analyzing and measuring reports of patients every month is an essential part of your medical business because it tells you about the improvement areas of your business that you need to work on the medical billing team or your staff. The past results show the monthly profits and revenues, performance, and efficiency of the team members and medical billers.

After a hectic day of treating patients and filling out charts, medical billing and coding are the last things providers deal with. But if they don’t deal with it, running their medical billing revenue will become a struggle. So, to keep getting paid on time and focus on patient care, many practice owners choose to outsource medical billing services. 

Medical Billing companies deal with complex procedures. These procedures are essential for the smooth running of their services. The difficulty starts when the patient schedules their appointments because it is the responsibility of the organization to keep and maintain the record until it is finished. Managing these hectic tasks needs excellent experience.

Problems:

Bad Documentation

Documentation is quite essential for every company. It is necessary for updated records because laziness in documentation can lead to medical billing errors. It can take place if the handwriting of a physician is illegible. Bad writing makes it harder to infer and input the information correctly.

Other Common Errors:

Incorrect entries of the patient information (Sex, name, DOB, insurance ID number, etc.)

Incorrect entries of the insurance company (Wrong policy number, address, etc.)

Incorrect codes confuse the multiple principles involved. It also includes mismatched codes. (Entering confusing ICD, CPT, or HPCS codes; entering confusing Place of Service codes; attaching conflicting or confusing modifiers to HCPCS or CPT codes; entering too few or too many digits to an ICD, CPT, or HCPCS codes)

You are placing the wrong amount of digits involved in specific codes. 

Missing Referral or Authorization

Some medical organizations require patients to get a referral from a physician or authorization before receiving physical therapy of their patients. If the referral or appointment is missing or not included, the claim will be rejected or denied.

Here is the solution again, you need to double-check with the patient health information (PHI) and make sure that your staff is expert in their work with all the requirements. If the referral is missing or denied, you can get it from the patient before submitting the claim. 

Incomplete Claim Information

A single empty or unchecked box on a claim can be all it takes to cause a denial. Even the most fundamental fields like gender, date of birth, and time of the accident or medical emergency are commonly left blank, which causes trouble and denial.

Make sure the second set of eyes provides (at minimum) a cursory review of each paper or electronic claim of your office files to make sure the required fields are completed. If you’re only working with e-claims, check that your software system flags users to review missing fields and input all required info before allowing them to submit. 

Mishandled Overpayments

Suppose the claim fails to process correctly because the payer has paid too much or too little. Claims that are underpaid need to be reformed instantly, and underpayments should be reviewed immediately as well. The mishandled overpayments should process correctly if applicable, and if a payer has failed to follow the proper procedure, the provider must notify them immediately.

A Lack of Data 

Problems can happen quickly if diagnosis codes are not correctly linked to the CPT – Current Procedural Terminology – resulting in claim denials or payment delays. Furthermore, this isn’t always a coding employee error because maybe there is an error in the diagnosis procedure. If a physician hasn’t provided the correct diagnosis information, this miscommunication can cause the problem. For this reason, it is so crucial for physicians to offer valid codes at all times.

Solutions:

Medical billing companies need to emphasize the importance of accuracy in this billing process. They should be proactive to ensure the correct information. Therefore, one should be careful about the documents and information they deal with the papers. It is also possible to minimize errors from taking place by following specific tips.

Coordination

Medical billing is not a one-person job, and it is teamwork. You require coordination with the various parties involved in the whole business. Moreover, the medical billing process majorly includes the care physician and the patient. You can work through any issues with proper coordination and good teamwork. If there is a possibility of popping any case regarding the information and claims, it can easily be solved.

Double-check

A fundamental concept that can help you minimize your errors and mistakes. You can revise it and confirm its accuracy by contributing and giving a little more attention to the details.

Keep Up With The Coding Trends

With time, the medical billing codes ought to change. It will help if you stay updated with the new trends and regulations of medical billing. The change occurs due to the addition in the policy of treatments and diseases. Therefore, a medical billing company should keep in touch with the possible emerging trends.

Follow-Up

Follow-ups are helpful in the identification of mistakes and errors. Through collaboration with an insurance company representative, you can learn about the mistakes and correct them promptly. This means you will be able to resubmit the claims before they get denied.

These solutions may help you to decrease the number of errors that take place. It is vital as medical billing errors can prove to be costly for the company. Follow-ups can avoid claims and mistakes, leading to the effective use of the above simple tips.

Final thoughts!

The outsourcing medical billing companies, such as UControl Billing, have highly trained experts who are well-versed in medical billing services. For more information, visit their website now! The highly trained staff of UControl Billing will keep an eye on the medical billing errors and prevent overpayments issues.