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4 Most Common Medical Billing Mistakes

Teresa Iafolla

Written by Teresa Iafolla

Staff who work in a medical office are in a fast-paced environment where mistakes can and do occur. By recognizing the most common errors, however, these mistakes can be avoided, saving the office time and money. Professionals are always looking at ways to improve in their job, so reviewing these common medical billing mistakes can help make you and your staff aware.

1. Unbundling and Upcoding

Upcoding is the practice of inflating a patient's diagnosis to a condition that is more serious, one that requires a more expensive procedure. Upcoding might also result from a clerical error or if the provider bills the patient with a service that is covered rather than the service that was performed,because the performed service was not covered by Medicare. Unbundling, on the other hand, is separate billing for for codes that should be included all in one code.

2. Duplicate/ Wrongful Billing

If a patient is billed for the same test, treatment, or procedure more than once, duplicate billing has occurred. Examples of wrongful billing can include billing the patient for services that were never performed or for the wrong service. Wrongful billing could also occur if a test or procedure was scheduled, then later canceled, but was never taken off the patient's account. Though most of these mistakes are simple human error, a facility can be fined for fraud for any of them.

3. Misunderstanding of an Explanation of Benefit (EOB) Form

EOB forms can be very complicated. You need experience to understand exactly what was paid, why a claim was denied or to determine if a claim was paid correctly. An insurer might pay only a portion of a claim or deny a payment. When a payment arrives that is less than anticipated, you must carefully read the EOB to determine the best strategy to to resubmit the claim for the proper amount. just accepting the initial payment can be a big financial mistake for the office. It's best to confirm that the insurer sent correct payment for all the codes.

4. Failing to Review Clearinghouse Reports

There's no doubt that medical offices are busy places, and taking time to review clearinghouse reports can be challenging. However, this is one critical step that must be taken to detect problem claims. The longer this is put off, the less likely the chance of those problem claims getting paid. These need to be corrected and resubmitted as soon as possible. An office can't afford to have a staff member say, "I just didn't have time to get to it." Make clearinghouse reports a priority in your office.

You have to realize there's a problem before you can fix it. Learning the most common mistakes made at your job can help you take preventive measures to ensure those problems don't occur within your office. You may even be able to make an action plan with your team to avoid some of these common errors to keep your office functioning effectively and efficiently!


Did we miss any simple mistakes that could impact practice revenues?

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Published: March 17, 2016