Top 10 Common Medical Billing Errors and How to Avoid Them
Medical billing mistakes happen all the time, & they can be a real headache for both healthcare providers & patients. Whether it’s a simple typo or a (medical) coding issue, these errors can lead to claim denials, payment delays, & minimal revenue. The good news? Most of these mistakes are completely avoidable. Let’s go over ten common medical billing errors and what you can do to steer clear of them.
It might seem small, but a simple typo in a patient’s name, date of birth, or insurance ID can be enough to get a claim rejected.
How to Avoid:
Always double-check patient details at check-in.
Verify insurance info before submitting a claim.
Use electronic verification tools to catch mistakes early.
Medical coding is tricky. Using the wrong code, an outdated one, or pairing the wrong diagnosis with a treatment can result in a denied claim. Upcoding (billing for a pricier procedure) & undercoding (missing services performed) are also very common slip-ups.
How to Avoid:
Stay updated on the latest ICD-10, CPT, & HCPCS codes.
Provide ongoing training for your billing team.
Use billing software with built-in code verification to catch errors before submission.
Accidentally billing for the same service twice can lead to claim rejections & payment delays.
How to Avoid:
Have a solid claims review process in place.
Use billing software that flags duplicate claims.
Ensure good communication between billing & clinical teams.
Unbundling happens when services that should be billed together under one code are separated, leading to overbilling.
How to Avoid:
Learn the bundling rules for different insurance providers.
Use coding software that flags unbundling issues.
Perform regular audits to catch frequent errors before claims go out.
Submitting a claim without confirming detailed info of patient’s insurance details can lead to denials if their policy is inactive or doesn’t cover the service.
How to Avoid:
Always verify insurance before an appointment.
Check deductibles, copays, & any pre-authorization requirements.
Use real-time eligibility verification tools to avoid any surprises.
Some treatments & procedures require pre-approval from the insurance company. If you skip this step, your claim is likely to be denied.
How to Avoid:
Train your team to check prior authorization requirements before scheduling procedures.
Keep a log of authorization requests & approvals.
Document authorization numbers in patient records before providing services.
Modifiers help provide extra details about a procedure, like location or complexity. Using the wrong ones can lead to denied claims & very reduced payment postings.
How to Avoid:
Ensure billing staff is well-trained in proper modifier usage.
Use billing software that suggests the correct modifiers.
Conduct regular coding audits to catch mistakes.
Insurance companies have very strict medical deadlines for submitting claims. If you miss them, you won’t get paid.
How to Avoid:
Track submission deadlines for different payers.
Automate claims submissions with billing software.
Set reminders to follow up on pending claims before they expire.
Insurance medical providers need proof that a procedure was medically necessary. Without proper documentation, they might even reject the claim.
How to Avoid:
Make sure providers document the medical necessity of each procedure.
Use clear, specific diagnosis codes that justify treatments.
Keep thorough and organized patient records in your EHR system.
Entering the wrong charge or missing a charge altogether can lead to lost revenue & compliance issues.
How to Avoid:
Review all charges before submitting claims.
Use automated billing software to reduce frequent human errors.
Perform regular audits to catch discrepancies.
Medical billing mistakes might seem small, but they can have a big impact. Taking the time to double-check information, stay up-to-date on coding rules, & use the right tools can make all the difference. With a little extra attention to detail, you can avoid these common errors, keep payments flowing, & make life easier for everyone involved.
