How Medical Billing Errors Negatively Affect a Practice

How Medical Billing Errors Negatively Affect a Practice

Medical billing errors are common. Insurance changes, coding mistakes, and even simple typos can cause payers to deny your claims. Here is how medical billing errors negatively affect your practice, and what you can do to prevent them.

What Are Medical Billing Errors?

Billing payers for your providers’ services is the financial backbone of your medical practice. If your practice submits claims for payment that are incomplete, not timely, or contain any errors, payers may refuse to reimburse you and issue a claim denial. Medical billing errors, even trivial ones, can delay your reimbursement and cost you time and money. Here are five common types of medical billing errors:

  • Incomplete or missing documentation: Some diagnoses, visits, and procedures may require documentation for payment. If this documentation is missing or incomplete, payers will deny your claim.
  • Insurance changes: Some patients, particularly those you see infrequently, may change insurance carriers between visits. Billing the old insurance carrier will cause a denied claim. You will then have to find the patient to get a corrected insurance to rebill.
  • Typos and other minor errors: Incorrectly spelled patient names, typos in insurance policy numbers, and other minor inaccuracies can cause a denied claim.
  • Coding: Diagnostic and procedure coding is complex, and payers may have specific coding requirements that your practice must meet for claims to be paid. Similarly, some payers require certain procedures to be coded as a bundle, rather than as separate services. This complex area of medical billing can create many claim denials, especially for smaller practices that may not have access to as many technical experts in coding and billing.
  • Delays: Many payers require claims to be filed timely. Delays in billing, either because of simple oversight or poor billing procedures, can cause denied claims.

How Do Billing Errors Hurt Your Practice?

Billing errors hurt your practice’s bottom line. Payers may deny claims that contain errors, have insufficient documentation, or they receive outside of the timely billing window. While you can correct some medical billing errors, like typos or insufficient documentation, the resubmission process delays your reimbursement. Fixing medical billing errors also requires time and attention from your billing staff. When your billing team members focus on correcting past errors, they may not have enough time to properly submit new claims, creating a vicious cycle of denials. Some errors, like late billing, may cause your practice to lose out on revenue altogether.

Medical billing errors can also reduce patient satisfaction. Payers may notify patients of a claim denial that resulted from an error by your practice, even if your team members are already working to fix the error. Calls from frustrated patients require time and attention from your front desk staff. If your practice does not fix medical billing errors quickly, patients may consider changing doctors to avoid further frustration.

Finally, if your practice struggles with medical billing errors, you may become a target for audits. The Centers for Medicare and Medicaid Services, as well as private payers, place increased scrutiny on practices with a history of inaccurate billing through fraud-prevention and auditing programs. Complying with audits can be time-consuming, and frequent audits may damage morale.

How Can You Prevent Medical Billing Errors?

Your EHR and EPM system can help to prevent medical billing errors. An integrated EHR and EPM system minimizes hand-copying of data, reducing data entry errors. These systems can also lower the risk of typos by pulling nearly all necessary billing information directly from patient records.

With an EHR and EPM, you can also streamline your billing workflows. Some common tips successful revenue cycle teams do are:

  • Verify patient eligibility with payers to ensure that you have up-to-date insurance information.
  • Have your front desk or insurance verification team correct eligibility issues prior to or during check-in and re-run eligibility.
  • You can also collect copays and enter them into your practice management system.
  • Enter authorization information needed prior to the visit.
  • Build a robust claim edit library to stop a claim before it goes out if it has incomplete or incorrect documentation.
  • Configure payer-specific rules in your system to catch and correct any errors before you send bills to each payer.
  • During office visits, your EHR system can warn providers about missing documentation or incomplete coding. These alerts save providers and staff from having to backfill information during the billing process.
  • Run medical necessity verifications on orders the physician is placing during the CPOE process.

EHR and EPM systems have tools to help you track your revenue cycle and pinpoint problems. For example, TempDev’s Revenue Cycle Dashboard NextGen EPM Report shows you aggregate and provider-level statistics on claims denials, including denial reasons. With a few clicks, you can see what share of your claims are being denied and why. Armed with this data, you can develop targeted training to help providers and staff prevent medical billing errors. 

TempDev Can Help You Reduce Medical Billing Errors

TempDev’s revenue cycle consultants and analysts can help you develop custom reports to identify the most common causes for medical billing errors in your practice. After performing a NextGen Practice Management Assessment, TempDev will work with the client to target their issues and rectify where the problem is occurring. TempDev’s NextGen experts can also help you configure your system to prevent medical billing errors, saving you time and money.

Call us at 888.TEMP.DEV or contact us to get started preventing medical billing errors.