Costly Errors in Medical Billing

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June 26, 2016 | Aptus Associates

Medical billing is a delicate business. For a physician’s office, medical billing codes are often confusing, and even downright disorienting. If you enter the wrong code, it could be rejected, and your office will not get paid for that particular visit. Enough rejected claims and you might have to go into debt. With enough debt, your office could bankrupt. More and more rural doctors are bankrupting. These are good doctors, who have never been involved in a malpractice suit, says CNN money. That’s a scary prospect, and a slightly extreme one but it shows you how serious it could be to wrongly bill. When they close, the rural areas they serve are left hours away from proper care. For patients in physical therapy or OB-Gyn patients, the options may be to drive far in an unstable condition, or to receive no treatment.

Don’t let your clinic join the statistics. Here are some costly things that could occur in billing, and how a billing company can save you.

Medical billing is so sensitive that one number or letter off could get your claim rejected. If you mistype your patient’s name with one L instead of two: rejection. If you give an outdated address you can be rejected. If you mess up the patient’s insurance number, you will be rejected. and those are all for your own good and your patient’s. You want their information to be totally correct when it comes to medical matters.

Beyond that, there are a host of codes you could confuse, or enter incorrectly. You could forget a service that must be billed. Leaving out something that should be billed is called Undercoding, and it’s just as illegal as Upcoding, which is tacking on services to bill for that did not actually occur. Everything must be perfect for a claim to be accepted. But like we know, no human is perfect and things happen.

If your mistake gets through the initial claim process, insurance companies do audits yearly. If they find an inaccurate claim, they can halt all money to that clinic until the claim is cleaned up. That could be a while depending on their caseload. Or, they could recoup (take back) money. Practices have had to fight in court for money taken back over incorrect claims from simple mistakes.

These mistakes and the stress they bring can be alleviated by hiring a professional medical billing company. Let us handle the claims, while you attend to keeping your patients healthy and strong.