There’s no easy way to say this, but medical billing and coding is a complex process which is highly vulnerable to healthcare organizations messing it up, which results in them being subjected to a penalty. Depending on who is in question, the patient, the provider or the procedure, the intricacies of medical billing and coding get profound with every revision. This is why healthcare practices are relying on billing and coding companies to make sure their revenue cycle is adequately managed, in compliance with the rules, so that they can focus on delivering qualitative treatment and care.
While outsourcing to billing and coding companies is highly recommended, it is equally advisable to have knowledge of mistakes that a healthcare organization should not make to avoid repercussions.
PATIENT’S INFORMATION ERRORS:
Did you know that not filling a single column in the patient health information form could result in claim denials? Yes, It is essential that every detail is accurately filled and checked in the patient’s chart from the spelling of the name to the insurance policy covering the patient, diagnosis code, procedure code, etc. While the denial gets re-filed, but the payment time gets extended, which no hospital wants.
NOT PERFORMING INSURANCE VERIFICATION:
Every time a patient comes for a treatment or procedure that is covered by their insurance company, it is the responsibility of the healthcare practice to verify the details of the insurance coverage. A patient’s information can change anytime, be it their first visit or second. Not performing a proper insurance verification will result in claim denial. Make it a point to check the coverage eligibility, plan benefits and service authorization.
When for the same tests and procedure a patient gets billed more than once, which can be intentional or by mistake, it will be considered as a fraud, and your healthcare organization can be subjected to a penalty for this wrongful billing. To avoid duplicate billing, the healthcare organization can implement and perform a chart audit, which will ensure that claims are billed correctly.
FILING CLAIM AFTER THE TIME WINDOW:
It is essential to submit a claim within the time window; otherwise, it will get denied. Note that the claim can be filled from the day the form was filled to one year from that. It is equally important to make sure that the claim is received before the end date; otherwise, it will be denied.
NOT CODING SPECIFICALLY:
It is crucial for the healthcare organization to make sure that the diagnosis codes are specific to the point of distinction with the maximum number of digits. Take, for instance, diabetes type1 and type 2 that should be distinctive property by the diagnosis codes. Using old coding books or writing the codes can be few cases, where diagnosis code had led to the denial of the claim due to an error in procedure match authorization.
NOT DOCUMENTING UNLISTED CODES:
Healthcare organization that use unlisted codes often don’t feel the need to document it, since it’s not listed. But this will affect the insurance claim, possibly denying it on account of code not being recorded. Doing this could subject you to penalty with your healthcare organization losing out on significant revenue.
UNBUNDLING THE CHARGES:
If Under a single procedural code, charges for various services dispensed is calculated individually, it will result in a massive bill. Since some on the procedures are bundled together, it can be challenging to identify the unbundling error, which is why the patient, as well as the healthcare organization, should stay vigilant.
They might look like honest and common mistakes but bear in mind, making them could cost your healthcare organization, a fortune. This is why outsourcing to billing and coding companies is a more practical and profitable choice. Not only is your time and money are saved for the long term, but you can also rest assured that your revenue cycle growth is guaranteed with compliance and zero worries about the penalty.