Medical offices tend to be busy environments, where frequent mistakes, and even the simplest, can and do happen.
Sometimes, your personnel is so focused on providing the highest quality patient care that the practice is renowned for that these kinds of mistakes happen. The fact is that a lack of compliance with practices and hospital guidelines regarding medical billing can have a negative and significant impact on your bottom number. Go to aha.org for a brief explanation of hospital medical billing.
The medical billing and coding professionals from Coronis Health want you to be aware of the mistakes that are most often made in hospital’s medical billing since they can be prevented by avoiding them, which can reduce the time spent by your staff and improve your profit. With our specialized expertise and global reach, we can aid medical facilities to get every dollar they need so that they can expand and remain in the same place. Below are five typical DME billing errors that our knowledgeable team can show you how to avoid.
1. Duplicate Practices and Hospital Medical Billing
This happens when a doctor is able to charge a patient twice for the same exam, test, treatment, or procedure. This is usually the result of someone in the office not being able to determine whether the patient has paid for the services. This could result in additional administrative burdens for your staff, as well as the payer as it could appear as if the patient received several services on the same day, but that’s not the reality.
2. Incorrect billing in hospitals and in Practices
The issue arises when a medical facility is able to bill a patient with incorrect services, or for services that the patient never received. Incorrect billing can also include billing the patient for a service that was scheduled but later canceled. Incomplete details on a claim could be the main reason behind the reason some claims are rejected. The errors could be as easy as inaccurate patient information or the contact details for the service provider.
These mistakes may appear minor and simple to fix in practice, especially for those who manually manage their billing using paper. While they’re commonplace among staff handling billing at the medical and dental practices, they could negatively impact your practice by affecting three aspects:
Incorrect billing can result in your accounting showing more money than you’re actually earning. This could mean extra time for your staff to identify and fix the problem.
Risk of Penalties: Despite mistakes in billing being relatively easy to fix, your business could be subject to penalties for fraud regardless of how unintentional the errors may be.
Reputation is even more crucial. is the impact on your reputation among your colleagues, patients, and even the general public. Who would recommend a practice which bills two times for the exact procedure or charges for an item that was not ever rendered?
There are, however, effective methods to avoid these mistakes. If your practice uses electronic billing software that categorizes billing, the errors are no longer a problem which means your reputation and bottom line are in good shape. Coronis Health staff stay trained on the top billing software, allowing us to connect to any hospital’s system and begin producing outcomes immediately.
3. Unbundling
Certain hospital medical billing codes are intended to be used in conjunction with the common procedures carried out in conjunction. If these procedures are billed separately this is referred to as unbundling. It is worth noting that unbundling is a criminal practice since it could increase profits of the practice and/or center if it is caused by a simple mistake. Unbundling’s consequences can be serious.
There are methods to avoid the error of unbundling. Keep up-to-date with the latest trends in billing and coding, since medical billing codes change often in order to comply with the most recent medical regulations, recently discovered ailments and illnesses, and new therapies. Your staff should be able to stay informed about the latest codes and billing practices. While it’s a bit laborious, it will help you save time, money, and possibly legal issues in the end.
4. Failure to adhere to Hospital Billing Guidelines Incorrect Coding and Upcoding
The process of upcoding can occur in two distinct situations. In the first instance, the diagnosis may be elevated or exaggerated from a state like moderate to one that is more serious i.e. it is one that requires an expensive procedure or treatment. Another scenario happens when a patient is being charged for a service that is covered, but not one that was not administered due to the service that was administered is not covered by Medicare. Both cases can result in an increase in your profits by demanding more fees than what you’re entitled to.
Under coding occurs when a practitioner does not include medical billing codes for cheaper procedures with the intention of avoiding an audit or saving money for the patient. Though it may be a result of a mistake, it can also be as suspicious and lead to grave consequences for your business.
What are the implications for your practice? While every kind of error in upcoding can be explained by a simple clerical error, most often because of being overwhelmed or under-staffed. However, the result is similar to incorrect or duplicate billing. your practice could fall into disrepute, increase the risk of enforcing penalties, and waste time trying to repair the harm.
The best method to prevent this problem is to make your employees get into the habit of checking their work or having an established checks-and-balances program that ensures that the chance of making mistakes can be reduced to almost zero. If you follow the guidelines for billing at hospitals it is possible to avoid a lot of the headaches that plague your facility.
5. Making a mistake when you confuse a denied claim with Rejected Claim
A claim that is determined to be ineligible by an insurance company results in a denial of the claim. This is usually because of billing errors or missing information. the coverage of the patient. In certain cases, denied claims can be eligible to appeal or reprocess. Your staff must be able to identify the reason for denial before a reconsideration request can be considered.
A claim that is based on inaccurate information about the patient or insurance or other mistakes can be rejected and is considered a rejected claim. Even transposed numbers in the identification number of a patient could cause an insurance company to consider declining the claim. The claims are not processed by the payer’s computer system. If the error is rectified and the claim is resubmitted, it will have to be submitted again.
What are the implications for your practice? If billing errors for hospital services or incorrect information about patients are caused by negligence by your staff, which is a regular practice that does all things by hand or without a suitable software system patients may lose confidence in your practice, and your staff may spend more time fixing the errors.
There are ways to reduce rejected and denied claims. Check your staff with you in case they have any questions regarding the best way to bill or the services to be billed. They can also follow on with patients prior to filing claims to ensure that all information is correct. By taking care at the beginning, it is possible to avoid problems after claims are made.