Top Five Billing Mistakes That May Be Costing You Patients

We all know it takes the smallest financial mistake to discourage a patient and make them doubt your front office staff’s abilities. Many a patient has been lost over an accounting error that went unaddressed too long or was just poorly handled. You are not alone. The Medical Billing Advocates of America statistics estimates as many as eighty percent of medical bills contain incorrect information. In this article we address the five most common medical billing mistakes that can cause delayed claims payments, unwarranted denials and errors in your patient’s billing.

1.) Incorrect coverage information. Whether your patient forgets their medical insurance card or your benefits verification specialist does an inaccurate breakdown there is no denying that this is the most commonly seen error in any type of healthcare billing. It is of the utmost importance, for prompt payment and to avoid denied claims, to ensure you have the correct information from the start. Always insist upon a copy of the patient’s medical insurance card, driver’s license and use it to get a copy of benefits from their insurance company.

2.) Anesthesia times. This is something we are not familiar with in dental billing. We are familiar with keeping anesthesia records however we don’t input those times on the claim. Medical claims require the start and stop time of any sedation codes. Make sure these are carefully noted so that you are not inadvertently charging the patient for more units of time than your records state. Mismatched records can lead to questions about fraudulent filings – even if they were simply an unfortunate mistake.

3.) Upcoding. Upcoding is the practice of coding a procedure with a much more serious or severe procedure or diagnosis code. It is considered fraudulent but is often done by accident by inexperienced medical coders. It is important to utilize experienced, certified coders that can accurately read your notes and superbills to assess whether the procedure and diagnostic codes are appropriate and the best applicable coding.

4.) Errors in coding. Another mark of inexperienced medical coders will be the use of incorrect procedure and diagnosis codes. This could either mean the wrong code for the type of procedure or it could mean using expired codes. The biggest change was the shift from ICD-9 diagnosis codes to ICD-10 codes. Experienced billers should know when submitting older claims which coding set applies to the date of service. There are thousands of diagnosis codes for every imaginable reason – it is important to have an experienced coder that does not make errors in choosing the most suitable diagnosis codes.

5.) Lack of preauthorization. This is another big mistake that occurs often in medical billing. Procedures should always be verified before completed, especially if you are an out-of-network provider, to ensure preauthorization is not required. Very few insurances allow for retroactive preauthorization (so if you make a mistake it is impossible to correct it and obtain payment) and those that do often only allow for it if the procedures were performed as emergency treatment.

If you don’t have the need for a full-time medical coder or there are limited qualified medical coders in your area you can always avail yourselves of the resources of a third party billing company. The most important thing is having someone who is experienced, knowledgeable and attentive to detail to prevent errors in claims submissions and errors in your patient accounting.

Dental Billing Tips and News for Pros; Edition #139


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Dental Billing