Reducing Billing Errors

by | Mar 23, 2018

One of the biggest problems we see in the American medical industry—for both practices and patients alike—is the matter of errors in billing. This is certainly a source of tremendous frustration on all fronts, but it’s also one that can be reduced by taking a few proactive measures.

Today, we want to look at why these errors happen and then discuss what you and your practice can do to keep them from happening.

Before we delve too deeply into the matter of reducing billing errors, it’s important to note this – doctors and their staff members are only human!

That means it is certainly possible to reduce the amount and frequency of billing errors made, but probably a bit unrealistic to expect them to be completely eliminated.

Of course, beyond the human element, even technology can let us down from time to time.

That said, we want your practice to thrive. And we have a proven track record of helping medical practices to improve performance by reducing these errors.

In any problem-solving endeavor—and, as a medical professional, you are probably quite aware of this—the first step is to understand the problem to the greatest extent possible. This starts with looking at why the situation can be considered problematic.

Errors in billing can cost your patients money. An audit of American hospitals found an average of around $1300 in undue charges for a $10,000 medical bill. Some people might not consider $1300 to be a lot of money, but this is a significant sum for a majority of Americans. (And even those who do have the money to spare would prefer to spend it in other ways!)

When patients receive erroneous charges—even if we aren’t talking about thousands of dollars—it damages the reputation of your practice. Patient trust is essential for a thriving practice. Anything that could erode this trust needs to be resolved ASAP!

Beyond the patients, billing errors are expensive for you. Sure, this can happen in the form of loss of appropriate reimbursement from the insurance company, but even needing staff members to resubmit claims that were denied or rejected on the basis of errors impacts your practice’s bottom line.

Finally, billing errors are a huge deal in the case of Medicare patients. The federal government and Office of Inspector have a “zero tolerance” policy when it comes to errant billing practices.

Clearly, there are several important reasons to ensure your billing practices are handled correctly the first time around.

This raises the question – where are these billing errors coming from?

Well, there are several common causes, including:

  • Incorrect or incomplete coding
  • Filling out fields incorrectly (with vital and residential patient information, provider data, etc.)
  • Insufficient or incorrect patient information
  • Poor handwriting
  • Failure to verify whether or not a policy covers the provided service
  • Failure to follow insurance company procedures
  • Missing deadlines
  • Double billing
  • Submitting claims for canceled or rescheduled appointments

In some cases, the mistakes can be attributed to new employees (who are unfamiliar with existing systems). In others, the problem is system-based, like when there is confusion as to whose responsibility it is to file a claim.

To figure out the root cause of your billing errors, you need to start by recording and compiling every incident wherein a mistake has happened. In doing so, it is helpful to create some general categories to assist with sorting the errors by type. (The bullet list above contains several potential categories you may wish to use.)

billing errors

Depending on billing error frequency, you may want to capture your data over the course of a month, quarter, or perhaps even six months. The important consideration regarding your timeframe for collecting information is that you give yourself a large enough sample size to tell the true story of what is happening.

Once you have a sufficient amount of data, it’s time to start digging. Look at your various categories and see which contain the greatest quantity of incidences. As we had noted, “incorrect coding” tends to be the most common billing error, so there’s a strong chance this is what you’ll see.

Depending on your particular case, measures you may need to implement for your practice include:

  • Utilize a billing service or clearinghouse from an independent source. ING’s clearinghouse, for example, can give reports on errors. In these reports, you can quickly see which your “top rejections” are—which is very insightful for identifying process-related errors—and compare practice rates to those which are considered to be typical. (Not nearly enough practices actually take advantage of these kinds of valuable resources!)
  • Make sure patients submit sufficient information to avoid “submitting code needs additional information” rejection. The likelihood of this particular situation can be reduced by training front office staff to make sure forms are filled out completely. Even better is to take the time to evaluate your forms and determine whether or not they are user-friendly and easy to see if relevant information is missing.
  • Designate a staff member to review and make sure correct modifiers are used, diagnoses are hooked up correctly, and combinations that shouldn’t be billed together aren’t. Keep in mind that having an actual set of eyes to review information is important because scrubbing software doesn’t always work in its intended manner – and especially in the case of podiatry (since the specialty doesn’t always follow the same rules).
  • Familiarize front office staff with patient charts. This will help to reduce the amount of errors on account of incorrect coding or incorrect information submitted.
  • Always verify insurance and review the details of coverage. Insurance verification is something that simply must happen every time. Reviewing coverage details will further reduce office error rate.
  • Create an office system to ensure every submission is new and not a duplicate. Duplicate submittals are a problem that can happen when there is confusion over who is responsible for submitting the claims.
  • Follow up as soon as an error is found. Yes, ideally this would not happen. Ideals are nice, but we live in the real world. Your goal is to reduce billing errors and not completely eliminate them (which is likely impossible). As such, your staff needs to make sure the problem is actually corrected and then follow the procedure for resubmittal.

At ING, we understand how important having a reliable medical billing service is to you and your patients. Our goal is to help your practice thrive, so contact us today and find out what we can do for you. Call us at (260) 927-1266 or connect with us online today.

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