The most crucial and difficult responsibility for each practice owner is to file error-free claims and obtain proper insurance payments. However, medical billing and coding is a necessary component of revenue cycle management, and executing it improperly can have serious financial repercussions, whether from overbilling that the practice would eventually have to pay back or from frequent claim denials in medical billing services california. We discussed 7 billing and coding errors that practice owners should avoid in our blog post.

Billing and coding errors to avoid in 2022

  1. Expenses not covered by a patient’s insurance: Practice owners most frequently make this coding error in medical billing companies. Every time a patient visits, practises are required to verify their benefits and eligibility. Verifying eligibility and benefits aids in determining insurance coverage for the intended procedure. Finding the number of covered visits, unpaid deductibles, and co-payments makes it easier to provide patients with an exact cost estimate and complete price transparency.
  2. Expired insurance coverage: With the aid of a benefits report, you may properly estimate costs with patients. A patient just needs to pay the co-payment sum at the time of the appointment in the case of medical services that are covered. Recovery of the patient’s obligation for non-covered care is quite challenging. And after the patient leaves the office, the chance of recovering patient payments diminishes as the days go by.
  3. The process of establishing whether a health insurance company is a primary or secondary payer to provide medical claim benefits for a patient having several health insurance plans is known as COB, or coordination of benefits. There is a lack of COB. Most clinics don’t request information about supplemental insurance. While processing medical claims, COB makes it considerably simpler to ascertain the primary payer’s obligations and decide the secondary payer’s participation..
  4. Lack of required precertification or authorization for an expense: Any claim that was turned down because precertification or preauthorization was required is regarded as a hard rejection, meaning that the insurance company cannot change its mind. Prior authorization requests have significantly grown as more people choose High Deductible Health Plans (HDHP). You must have a list of procedure codes that may need prior authorization based on your medical expertise. As was previously said, it might be very challenging to get a claim approved if prior authorization was not obtained.
  5. Providers can reduce claim denials by making sure their clinical notes are succinct, in-depth, and explicit. One of the main causes of denials is a diagnosis that is too general. You will find the most precise diagnosis code and speed up the payment of your claim by including clinical information such as the severity of the problem and whether it is chronic or acute.
  6. Non-Documenting Time-Based Services: Documentation is required whenever time is employed to report E/M service codes. Most providers employ a small number of procedure code groups repeatedly for all procedures, which could result in a coding audit.
  7. Other Errors: In addition to the errors listed above, other errors include the following: the note is unsigned; the names of the billing provider and the service provider do not coincide; the note does not support the CPT codes reported for it; the CPT codes are inconsistent with the location of the service; the patient has used up all of their benefit dollars for the period; the claims are duplicated; the procedure/modification combinations are incompatible; and the referral(s) are not listed on the claim.