Common Medical Billing Mistakes Which Affect Your Revenue
Medical billing has a major impact on a practice’s profitability.
Efficient billing practices provide timely and correct reimbursements for the services performed.
However, healthcare providers can experience revenue losses due to several common medical billing errors.
We’ll give you an overview of the top five medical billing mistakes and explain how they impact medical billing and how to avoid them.
1. Coding Errors
To ensure proper billing, medical coding must be accurate.
Coding errors, such as incorrect Current Procedural Terminology (CPT) codes or International Classification of Diseases (ICD) codes, lead to claim denials or underpayments.
Mix-ups in patient information – like names, birthdates, or even genders.
These errors are often caused by misinterpretation of documentation, coding, or software malfunctions.
Impact: Coding errors can result in delayed or denied payments, affecting your revenue stream.
Furthermore, consistent coding errors might trigger audits, resulting in legal and financial complications.
Prevention: Training coders regularly, implementing automated coding software, and conducting internal audits can reduce coding errors.
Coders and healthcare providers can work together to ensure accurate coding.
2. Insufficient Documentation
Medical billing issues are often caused by incomplete or flawed documentation of medical services.
Claims must include more information about the services, medical necessity, and the patient’s overall condition to substantiate the charges.
Impact: Insufficient documentation can result in claim denials, delayed payments, and even allegations of fraud. Revenue and credibility are at risk for healthcare providers.
Prevention: Encourage healthcare professionals to maintain thorough and detailed documentation of patient encounters. Offer staff members proper record-keeping training and implement standardized documentation practices.
3. Failure to Verify Patient Insurance
You are committing a costly error when you fail to verify insurance information before providing medical care.
It can be costly to overlook a patient’s insurance details.
Claim rejections and payment delays can be caused by out-of-date or incorrect insurance information.
Impact: Remembering to verify patient insurance can result in increased accounts receivable, strained patient relationships, and improved cash flow — this mistake affects both revenue and patient satisfaction.
Prevention: Verify insurance before appointments or procedures.
Make sure that insurance information is current and accurate by utilizing technology.
4. Upcoding or Undercoding
Upcoding refers to assigning higher-level codes to services than what was performed, and undercoding refers to using lower-level codes.
A billing discrepancy or financial loss can result from either of these practices.
Impact: Upcoding can attract audits and penalties, while undercoding may lead to underpayment for provided services.
In both cases, revenue is compromised, and the practice’s reputation may be negatively affected.
Prevention: Provide coding education to your team to ensure accurate code selection.
Review claims regularly for patterns of upcoding or undercoding. Maintain compliance through internal checks and balances.
5. Ignoring Follow-Up on Denied Claims
Denied claims often need to be addressed on time.
In many cases, denied claims require thorough investigation, corrections, and resubmission.
Impact: Neglecting denied claims can lead to a significant loss of revenue. With timely follow-up, legitimate reimbursement might be possible.
Prevention: Establish a systematic process for monitoring and addressing denied claims.
Make sure your staff analyzes denial reasons, corrects them, and resubmits claims as soon as possible.
Avoiding common medical billing mistakes is essential to maximizing revenue and maintaining a financially stable medical practice.
Accurate coding, comprehensive documentation, insurance verification, proper coding practices, and proactive denial management are important factors that contribute to successful medical billing.
By recognizing these pitfalls and implementing effective strategies to prevent them, healthcare providers can ensure consistent revenue flow and improve their bottom line.
If you’re finding billing challenging in your medical practice, contact AR Rescue today to increase revenue and simplify the process.
When you partner with AR Rescue, you can expect fewer claim denials, faster payments, and a healthier financial position for your practice.
With a financial safety net, helping people heal and running your practice can be your primary focus.
Invest in your financial future with a personalized consultation today.