10 Common Medical Billing Problems That Lose Practices Money and How to Resolve The

Managing the financial health of a medical practice often involves navigating the complex landscape of medical billing. Common issues like coding errors, tracking of claim statuses, insufficient documentation, and more can become stumbling blocks in your revenue cycle. 

These seemingly small yet significant problems can lead to substantial losses in revenue over time. However, by understanding these common billing mistakes and how to resolve them, you can ensure that your practice is financially sound, and provides efficient and uncompromised care to patients. This article aims to enlighten you about these pitfalls and their solutions.

10 Common Medical Billing Problems and How to Resolve Them

Auditing your billing operations is critical to ensuring the financial health of your practice. We’ll delve into 10 common billing problems that could be draining money from your practice.

1. Incorrect Patient Information

Incorrect patient information can pose a significant challenge in medical billing, often leading to denied claims. When the patient’s data is inaccurate, such as misspelled names, incorrect IDs, or faulted addresses, it creates a discrepancy between medical records and databases. 

To alleviate this problem, ensure your practice has robust procedures for collecting and validating patient data. Encourage your staff members to double-check all the collected information before submission of claims. Ask for the information again if it’s inaccurate. 

2. Unbundling of Charges

Unbundling is a common medical billing issue in which services that should be billed as a single procedure are separated and billed individually. By ‘unbundling’ these costs, the practice may initially receive increased payments, but this behavior can lead to major issues with providers.

Avoid unbundling charges by ensuring that your billing staff is aware of bundling rules and regularly updated on changes. Opt for comprehensive medical billing software that’s geared toward detecting and preventing such occurrences, as this will avoid fraudulent claims. 

3. Duplicate Billing

Duplicate billing is an unnecessary problem that really hits your bottom line. It happens when you accidentally bill a patient twice for the same service or product. In some cases, this error is due to oversight or lack of proper monitoring within the practice, but this can be solved. 

A solution for staying on top of it involves using medical practice management software. This reduces human error and ensures that duplicates are spotted before they cause financial issues. As a result, you can maintain trust and confidence in the profitability of your practice.

4. Expired Insurance Policy

Billing for services provided to patients with expired insurance policies usually leads to payment rejection and loss of revenue for the practice. Ensuring the patient’s insurance coverage is still active before they receive services must be a standard procedure within your practice. 

By incorporating this step into your process, you can identify if the policy has lapsed and advise the patient correctly, either by discussing alternative payment options or rescheduling until they receive coverage. This proactive approach prevents losses pertaining to uncollectible payments.

5. Inadequate Documentation

Inadequate documentation is another significant issue in billing that can negatively impact your practice’s earnings. If the necessary paperwork or corresponding proof for a provided service is missing or incomplete, claims cannot be validated, leading to non-payment for those services. 

Ensure your process includes comprehensive documentation for each service you provide and strive to keep patient records up-to-date. High-quality record-keeping will streamline your billing process, differentiating between more successfully billed claims versus denied ones.

6. Too Many Charge Entry Errors

Charge entry errors, such as wrong service codes or prices, can lead to an overwhelming number of denials or underpayments for your medical practice. These inaccuracies might seem small, but they compound and result in substantial financial losses over time. 

To resolve this problem, you should regularly review and correct entries before submission to insurance companies. Implementing sophisticated billing software and adequate training can also help minimize these errors by alerting your team when incorrect entries are made. 

7. Upcoding and Under coding

Upcoding refers to instances where the codes used for billing represent more severe or expensive treatments than those actually provided. On the other hand, undercoming occurs when the treatment provided isn’t adequately represented in the billing. Both are bad.

Both lead to inaccurate reimbursement, can cause legal issues, and result in loss of credibility for your practice. To resolve this, ensure coding accuracy by providing regular training for your team on updated coding standards. Moreover, adopt more stringent auditing processes.

8. Forgetting to Verify Insurance Coverage

Forgetting to verify a patient’s insurance might lead to treatments not being covered, thus turning into unpaid claims and hurting your bottom line. To fix this, implement a standard procedure requiring staff to verify patient coverage status before any service delivery. 

Through the use of technology or software that confirms insurance eligibility in real-time, your practice can avoid claim denials and ensure continuous cash flow. It involves an upfront investment in time, but offers gains in operational efficiency and profitability in the long run.

9. Not Following up on Denied Claims

Not following up on denied claims is something your practice can’t afford. Unresolved and unpaid claims translate into lost revenue over time. Sometimes, these denials may simply be due to minor errors that can be corrected and resubmitted for successful reimbursement. 

To resolve this issue, establish a diligent follow-up procedure that tracks denied claims, reviews the reason for denial, rectifies the issues, if any, and promptly resubmits them for processing. Learning from these denials helps refine your billing process to reduce future denials.

10. Minimal or No Training in Medical Billing Practices

Lack of training in medical billing practices among staff members is a surefire way to run into trouble. Efficient medical billing requires specialized skills and updated knowledge about changing regulations. Without proper training, staff are more likely to make mistakes. 

Ensure your team is well-trained and enlightened about the latest changes in billing rules and regulations. Investing in employee development is worth the cost, as it leads to reduced errors, improved patient satisfaction, and, ultimately, enhanced revenue generation for the practice.

In Conclusion…

Navigating and resolving common medical billing issues is crucial to fostering a financially healthy practice. But it’s important to remember that you’re not alone in this journey. With the right approach and mindset, these challenges are surmountable. Keep enhancing your knowledge, continuously train your team, and stay patient to eventually see improvements. 

Charles Bains

Charles Bains

Charles Bains started his insurance career as a marketing intern before pounding the pavement as a commercial lines agent in Orlando, FL. As an industry journalist, his articles have appeared in a variety of trade publications. His insurance television career, short-lived but glorious, once saw him serve as the expert adviser on an insurance-themed infomercial (yes, you read that correctly). Having recently worked for various organizations, coupled with his broader insurance knowledge, Charles is able to understand our client’s needs and guide them accordingly. He is a gem for Insurance Noon as his wide area of expertise and experience have been beneficial in conducting further researches to come up with solutions and writing them in a manner which is easy for everyone including beginners to comprehend.

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