Most Common Medical Billing and Coding Errors

A healthcare center’s medical billing and coding section is considered one of the most complex areas where even a minute error can lead to denials in claims and payments. Can you comment that medical billing and coding are all accurate? No, even highly trained teams can also make errors that are quite common.

Most common medical billing and coding errors can lead to denials in claims, payment losses, and center’s federal penalties. Considering how complex the medical coding system is, it is not surprising that incorrect claims can occur.

So, let us take a look at why medical coding is important and some common medical billing and coding errors:

Why is medical coding highly significant and important?

Medical coding is the process of charging services provided into billable revenue. Each service has its own corresponding Current Procedural Terminology (CPT) and codes. These bills are then submitted to insurance agencies like Medicaid, Medicare, and others with the codes to pay for the healthcare institute.

When inaccurate medical coding errors happen, reimbursements can be delayed, partially paid, or even denied. When multiple errors occur, it leads to a backlog in payments which, in turn, loses revenue for the hospital or the center.

What are some consequences of inaccurate coding?

If an institution or a practice has multiple inaccurate coding or billing mistakes, then it can lead to intense scrutiny and can also lead to serious fines and penalties.

Medical abuse also occurs when the billing team falsifies claims deliberately or unintentionally. Submission of such claims to the Government is in violation of the Federal Civil False Claims Act. Civil penalties for violating these rules result in three times the damages. The fraudulence of healthcare benefit programs can also include imprisonment.

As a patient, the consequence of producing incorrect billing means not getting reimbursed by insurance agencies.

What are some medical billing errors that can occur?

Not enough data sets:

One of the main reasons for medical billing mistakes happens when the institute does not provide accurate information to support the patient’s claims. This results in a claim being denied. The top reason this happens is due to errors in updating information of patients, insurance agencies and providers.

Two examples of where coding errors can occur are:

When the billing department does not link a diagnosis code to HCPCS or CPT code
When an error occurs by the employees in the healthcare centre where a physician or nurse adds inaccurate information

Wrong medical billing codes:

When the billing department uses a code for a more expensive procedure or wrong billing codes, upcoding occurs.

An example of such an error is a doctor meeting a patient for 10 minutes over a routine health checkup, but the coder bills them for a complete checkup.

When such inaccurate medical coding errors occur, it can lead to demands for higher payments and illegally inflates the revenue as well.

Undercoding or overcoding errors:

The terms undercoding and overcoding are both fraudulent practices that can result in the institute being audited and investigated. Undercoding is reporting more affordable medical services than what was performed, whereas overcoding occurs when a patient is not charged for any treatment provided. These are generally not errors but medical abuse that must be avoided.

Not updating code sets:

The Medicaid and Medicare centers have set up the NCCI to ensure that the right coding methods are followed and that illegal practices can be avoided. Medical organizations keep up the clinical coding sets and update them manually every year. So, hospital coders must keep track of new codes and change the old ones to use them correctly. This is why authorities like AHIMA and AAPC need members to complete annual training to be updated about the codes.

Documentation is not up to mark:

When healthcare sector employees like doctors and nurses turn in paperwork that could be more accurate, it can be hard for medical billers to assign the right codes and bill their patients properly. In some cases, bad handwriting can also be a cause due to undercoding or overcoding. In some cases, healthcare providers need to update the right procedures performed, which leads to insufficient data for billers. So, there is a high chance of leaving important data or information out of the billers’ reports, leading to medicine billing mistakes.

Coding errors in telemedicine:

In today’s digital world, modern technologies in the healthcare industry have increased telemedicine. Patients now do not need to leave the comfort of their homes, and this is becoming highly popular. In the present situation, healthcare providers can connect with their patients anytime and provide intervention when required.

Regarding errors, telemedicine has created complications in the entire billing process—cases where using incorrect modifiers for the telemedicine industry can lead to delays in payments.

Unbundling:

The process of using multiple codes for procedures that are linked to one another when there is already a single code for the procedure as a whole is known as unbundling. This act is illegal as it can increase costs and cause misunderstandings in the billing process.

How to prevent medical billing and coding errors?

The best way to reduce errors in medical billing are:

Getting claims management software installed

They provide real-time information and can be directly linked to any code upgradation that happens yearly.

Offer training for some common claim denial reasons to the team

To make sure that your team is highly efficient, it is better to train them to avoid issues such as:

Missing details
Any service that is not covered by insurance
Duplicity in services or claims
Any service already adjudicated
The limit for filing of documents

Outsourcing the billing team

Medical coding is an immensely difficult process that can be difficult for even the most experienced team. Any error can cause major damage, which is why it is better to outsource the entire process. The benefits of these include:

Lesser errors as the staff are more focused
Lower costs incurred
Patients more satisfied
Increase in revenue and cash flow
All compliance maintained
Better consistency in billing

Key Takeaways

Today’s healthcare private practices more often face medical billing and coding issues than ever. Erroneous coding can cause imprecise compensation, and can lead to legal actions against your coding practice. The best approach to sidestep the penalties of medical coding and billing errors is to partner with specialists that hold expertise in medicine billing and revenue cycle management.

As a healthcare center or private practice having the best medical billing and coding practices will help make your patients’ lives easier. It will also save you from fraudulent practices and audits. If you feel this task is too difficult for your team, try outsourcing your medical billing to a provider. Ask them questions that will determine whether they follow all details set by the Department of Health.

FAQs

1. What are the possible reasons for medical billing and coding errors?

Some possible reasons for medical billing errors are:

Improper documentation
Missed details
Upcoding
Unbundling
Undercoding or overcoding

2. What are the ways to prevent medical billing errors?

Healthcare centers can prevent medical billing errors by:

Preventing upcoding
Making sure all patient details are properly registered
Updating codes and training team
Outsourcing the billing department

3. What are common medical coding errors?

Some common medical coding errors that can occur are:

Upcoding
Failure to check the NCCI code upgrades
Unbundling of codes

4. What is an error in medical billing?

An error in medical billing means any mistake such as name spelling, details, policy details, or error in procedural codes. This is often a human error that occurs due to time constraints.

5. What are the best practices to improve medical billing and coding accuracy?

Some of the best practices to help improve accuracy in medical billing and coding includes:

Staying updated with changes in codes
Eliminating any inefficiencies, such as handwriting errors
Automating the management process to help maintain medical billing accuracy

6. What are some of the most common medical billing codes?

The most common and highly reimbursed CPT codes in 2022 are 99213 and 99214. As per Definitive Healthcare, over 4.2 percent of all Medicare payments amount to over $5 4.1 billion.

7. What are some of the most common errors when submitting claims?

The most common errors when claims are submitted are:

Errors in patient details such as name, DOB, gender, etc.
Adding incorrect or mismatched codes
Leaving out codes or adding unnecessary codes

8. How can you identify and resolve medical billing errors?

If you see any errors in your medical bills, then contact the respective hospital and connect with the billing department. Explain the problem and why you feel there is an error.