It’s a fact that a large part of a practice’s revenue comes from successfully processed claims. And it’s also a fact that even one small error in the processing of these claims can mean immediate rejection or denial, and the loss of revenue.
These facts are the reason why it is absolutely critical that claims be filed free of errors. In an office that handles numerous claims daily however, it can be difficult to keep track of every single detail in each claim. Knowing the most common errors committed when filing a claim can remedy this. By taking note of the most common errors or having a checklist of these nearby when filing, you can make sure to avoid most, if not all rejections or denials.
Common Input Errors
Probably the most common of these errors involve information that is included or excluded in the claim. These include:
• Incorrect patient information (name, gender, date of birth, insurance information, etc.)
• Incorrect insurance provider information (address, contact information and policy numbers)
• Incorrect or switching of codes (CPT, point of service and other codes that are mixed up)
• Codes that have excess or missing digits
• Mismatched diagnostic and treatment codes
• Missing codes for all or some of the services performed
Other Avoidable Errors
Apart from the actual information being entered into claims, there are certain erroneous actions which also cause rejections or denials, and must therefore be avoided. These actions include:
• Upcoding – This involves entering codes into a patient’s bill for services which were not given, or entering codes which are higher in cost and complexity than the services given. This is often done to inflate the total amount to be paid by the patient. This is illegal and can lead to fines and even criminal prosecution.
• Downcoding – This is the opposite of upcoding, whereby some codes are left out of the bill or purposefully under-coded to minimize a patient’s cost or to avoid audits. While it may have the opposite effect of upcoding, it is still illegal and can also lead to legal repercussions.
• Duplicate Billing – This occurs when a patient is billed for the same service more than once. This often occurs out of negligence.
• Failure to Verify Patient’s Insurance Coverage – Sometimes a patient’s health insurance coverage will change without the patient’s knowledge. It is a must therefore to verify insurance coverage directly from the provider.
Aside from taking note of the most common errors when filing a claim, there are many other ways you can avoid costly rejections or denials. One of the most effective ways you can do so is to partner with a reliable billing company like Park Medical Billing.
Park Medical Billing combines years of firsthand, medical practice management experience with IT expertise to deliver exceptional medical billing solutions that can be customized to suit your specific needs. Simplify billing and maximize results and revenue with Park Medical Billing. Call us now on 1-201-585-7306.