Medical billing challenges and their solutions

Whether it’s a freestanding surgery center, a regular care hospital, or a medical office practice, there are some medical billing issues that can impact your revenue and how customers perceive your business. Knowing about these issues and how to solve them can be a great way to ensure you face no challenges. Here’s everything to know:

#1 Incomplete or Missing Information

It is surprisingly common for businesses to leave out information that they don’t deem necessary. This includes the patient’s personal information such as their date of birth or date of injury. The insurance company has the right to decline a claim if there is missing information. In fact, about 20 percent of all denials are said to be linked to missing information. The resolution process is both lengthy and tiring. The best option is to carefully scan all claims before submissions and ensure there is no information missing. Don’t leave blank sections and have someone review claims before they’re forwarded for approval.

#2 Confusing Invoices

Patients often have a difficult time reading or understanding invoices. They don’t always understand the terms on the invoice and may have questions related to costs and payments. This is a huge challenge as the practice needs to hire a dedicated staff member to quickly and smartly handle such queries. Since it can be hard to find and retain qualified employees, it is best that you work with a full service medical billing company like Park Medical Billing. We have a dedicated team to take care of all patient inquiries such as answering patient questions, explaining invoices, and offering patient-friendly collection methods.

#3 Incorrect Information

This is one of the most common medical billing mistakes that can cost businesses catastrophic losses. According to Becker’s Hospital Review, about 80 percent of all medical bills contain errors. While some experts believe this number to be in the range of 30 to 40 percent, many other reviews agree with the Becker’s Hospital Review report. These errors or mistakes cause hospitals more than $68 billion per year. We know you don’t want to suffer such losses and the best way to avoid these issues is to be careful and use a reliable medical billing tool. Incorrect billing isn’t only a financial risk but also a legal risk. Errors such as charging your clients for services not confirmed can result in fraudulent charges, even if they are minor mistakes. Plus, they are a threat to your reputation and can impact your image. Who would want to recommend a practice that bills for procedures not performed? An effective way to eliminate the risk is to verify the claim information and red flag mistakes for review through the use of specialized billing tools. #4 Double Billing One of the biggest culprits is duplicate billing. In fact, more than 411,000 seniors faced issues related to duplicate billing for their Medicare premiums in September 2019 alone. The mistake was due to a system glitch; however, some reports show that duplicate billing is also linked to fraudulent activities. Nearly 46 percent of provider-related fraud cases are linked to duplicate billing and invoicing for services not required. Providers are answerable to the government and they have to be very careful when preparing invoices. Duplicate billing occurs when a practice charges a patient two or more times for the same procedure. These mistakes occur due to a variety of reasons, including inexperienced staff members, carelessness, and poor management. The best way to reduce the risk of duplicate billing is to use an automation tool that can identify duplicate bills by matching information such as invoice number, date, name, etc. In addition to this, you can consider creating proper keying procedures and establishing an end-of-day invoice review.

#5 Incorrect Patient Identifier Information

Insurance companies are known for denying claims over minor issues such as spelling mistakes or wrong dates of birth. These minor issues are easy to resolve but they can lead to a prolonged revenue cycle and put unnecessary pressure on your business. Instead of having to go through the process of correcting things, you must take steps to prevent such mistakes from ever happening. The solution lies in linking your billing system to your Customer Relationship Management (CRM) tool or Practice Management Software (PMS) so that all relevant information can be easily imported. A PMS can be a better option as it allows information to be verified. Still, if you have your team members filing information manually then ask them to always double-check every entry and to be very careful when entering information.

#6 Incorrect Coding

This may come as a surprise to some but improper coding is one of the most common mistakes made by medical services providers. This occurs due to a variety of reasons, including the use of old or outdated coding books, missing codes, unbundling of charges, underbilling, overbilling, and using CPT codes that are not included in your insurance carrier’s contract. Some of these coding issues, such as underbilling and overbilling, are related to fraud, however, they may also occur due to genuine mistakes. Billing software that include coding automation can help solve this problem. These tools are designed to list only relevant codes, leaving no room for such errors.

#7 Not Following Up

A denied claim is not the same as a rejected claim. A rejection occurs before the claim is processed, whereas a denial occurs when a claim has been processed and found to be unpayable. This can happen due to a variety of reasons such as missing information or incorrect data. In these cases, your team may have to make some changes to ensure the claim gets processed. However, nearly 25 percent of unpaid claims are never followed up on. In fact, write offs cost up to $3.5 million. A great way to solve this problem and avoid these common medical billing challenges is by working with a medical billing company like Park Medical Billing. We offer all services related to medical billing and can help your practice “get paid”. Call 201-585-7306 today to start a conversation.    

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