Medical claims are required to be accurately generated and submitted to obtain complete reimbursements for the medical practice. Any form of errors on these claims during medical billing and coding can cause them to be denied. The denied claims interrupt the revenue cycle process and delay obtaining revenues for the medical practice. To prevent such delays, the following common mistakes can be avoided while generating claims:
· Coding Issues
Coding inaccuracies such as upcoding and down coding can lead to fraudulent claims. In upcoding, the coders input higher-paying medical codes on the claim, which result in higher bills for the patient. Conversely, in down coding, the low-paying codes are entered on the claim, causing a lower bill for the patient. In addition to such coding errors, failing to comply with the coding classification systems such as ICD, CPT and HCPCS can also lead to claim denials. The medical coders need to be trained regularly to keep their coding knowledge contemporary. They need to prioritize medical billing and codingspecificity and re-check the coding inputs before submitting claims.
· Missing Information
Claims are denied due to a lack of accurate information of the medical encounter. All the details pertaining to the date of medical emergency, date of patient appointment, patient name, insurance plan code and other specifications need to be entered accurately in the claim. Any errors in the information entered such as misspelling patient’s name, entering wrong date of birth and incorrect insurance information can lead to the denial of claim. Therefore, the medical billers must enter precise data in the claims, without any information gaps.
· Failing to File Claims on Time
Claims can be filed anytime starting from the date of the medical service rendered till the end of the claim submittal period. The claim submittal period ends precisely one calendar year from the start date. It is important for the claims to be received by the insurance providers before the end of the submittal period. Therefore, even if the medical billers successfully submit the claim before the end date, but the claim gets received after the end of submittal period, then the claim is said to be denied. To ensure acceptance of claims, the medical billers must file the claims in a timely manner.
Most medical practices outsource their medical billing services to avoid such common mistakes. They choose to outsource their billing needs to well-established medical billing and coding companies, to leverage on their experience and expertise. By outsourcing, healthcare providers can save investing on infrastructure, payroll, employee maintenance etc. They also ensure complete reimbursements for their medical practices by utilising expert medical billing services of renowned medical billing and coding providers.