Medical Billing Uncategorized

5 of the Most Common Medical Billing Errors and How to Fix Them

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Medical billing errors are common, but exactly how common isn’t clear.  Several studies have attempted to quantify the extent of the problem, but each has arrived at a different conclusion.  Among the more startling of these is a 2015 study from Equifax, reported by ABC news:

“A group of auditors hired by insurance companies recently found errors in over 90 percent of the hospital bills they examined. An audit by Equifax found that hospital bills that totaled more than $10,000 contained an average error of $1,300.”

The Cost of Medical Billing Errors Is High

The cost of billing errors to healthcare organizations, even at low-end estimates, is prohibitive.  For example, a write-off rate as low as 1% could cost the average 300-bed hospital as much as $3 million in lost annual revenues.  At 10%, that cost jumps to $30 million.  Those kinds of losses are not sustainable.  To remain financially viable, healthcare providers must become proactive in managing billing claims and implementing safeguards against billing errors.

What Are the Most Common Medical Billing Errors?

There are multiple types billing errors, but, according to the 2013 American Medical Association National Health Insurer Report Card, 5 occur much more frequently than the others. Here they are, along with ways to avoid them:

  1. Missing information:  often, demographic information on claims is missing or incomplete. Fields such as birthdate, or a complete address, can delay the processing of a claim.  In addition, coding errors or usage of outdated codes can cause claims to be denied or delayed. All billing systems should have robust “scrubbing” software to catch common errors prior to the claim being submitted electronically.
  2. Submitting 2 claims for the same service:  these mistakes are often referred to as “duplicates.”  Duplicates occur when a claim is resubmitted for the same service by the same provider on the same date, and for the same beneficiary.  Providers need to train staff to ensure that every submission is new and has not already been submitted.
  3. A service was previously adjudicated:  this happens when providers bundle procedure codes and include benefits for a given service in payments for another service.  To avoid this error, providers should implement a unified process that aligns the team on the adjudicated process.
  4. Services are not covered by the patient’s insurance:  this is among the most common, and most expensive, of medical billing errors.  According to the U.S. Government Office of Accountability, the rate of denials (including those based on medical necessity) nationally because services or procedures were not covered was 19%.  What’s striking about this mistake, especially considering its pervasiveness and cost, is how relatively easy it is to avoid.  Providers simply need to review the details of each patient’s coverage and contact the insurer if they have questions.
  5. Filing medical claims too late:   providers are aware that payers typically impose time limits for the submission of claims.  (This includes a 60-90-day time limit on the initial claim, and, if the claim is denied, an additional 45-day limit to appeal the claim.)  If the initial claim is not filed in a timely manner, there is little a practice can do other than write off the amount.  As with the other mistakes noted here, this one has a relatively simple fix:  providers simply need to create a system in which staff receive automated alerts as medical claims approach their time limit.

Reducing Errors Requires a Team Approach

One thing is certain:  playing the blame game is not going to reduce medical billing errors.  Every member of the team has a role to play, and every team member is ultimately accountable when errors occur.  For example, as a report issued by Health Data Consulting notes, physicians are not without their share of responsibility for billing errors, many of which occur based on inaccurate clinical documentation at the time of care.

It can be challenging for medical providers to bring that degree of introspection to their internal processes.  Often, knowledgeable professionals from the outside can be more effective in identifying the causes of billing errors, and to fix them systemically.  To learn more about the ways our medical coding, accounts receivable recovery and monitoring, analytics, and coding audit services can bring greater efficiency to your healthcare organization, contact us today.

Topics: AnalyticsMedical CodingHealthcare ConsultingMedical BillingAccounts Recievable ManagementClaimsMedical InsuranceFinancial Monitoring


Financial Health Medical Billing

Addressing the Financial Health of Your Medical Practice

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Maintaining a financially healthy medical practice is important for many reasons. 

On the most basic of levels, it allows you to keep the doors open. You can retain employees, keep morale high and remove the headaches associated with worrying about money month to month. Most importantly, though, it allows you to better serve your patients.

How so? A financially healthy practice is able to plan long-term for future needs. With a secure, stable revenue stream, you can do things like hire more employees, improve your facilities, invest in new technology, and offer more development opportunities for staff.

Of course, this revenue is all tied back into the rate at which a practice receives payments from insurance companies. The longer charges stay in accounts receivable, the longer it takes your practice to get paid for the services performed. Ideally, your practice should only have to submit a claim to insurance once for it to then be paid, but this isn’t always the case.

So where does your organization stand? To help you get a better grasp on where your organization stands, look at these key questions and national averages below.

How many days of charges are in accounts receivable?

The average practice has charges in accounts receivable for 35 days. Remember, the higher the number of days, the longer it takes for you to be compensated for your work. If your number is 35 or higher, then you need to begin taking steps right now to lower it. Even if you are below 35, there are most likely opportunities for you to lower your days in accounts receivable to be even fewer.

What percentage of your accounts receivable is over 120 days?

In an average practice, 18% of claims have been in accounts receivable for over 120 days. Claims unpaid after 120 days require additional, urgent attention in order to receive payment, creating more work and slowing down your practice.

What percentage of claims are paid on first submission?

The average first claim pass rate is 85%. If you are regularly resubmitting claims multiple times, then it’s time to pinpoint and rectify the reason insurance keeps refusing payment.


Medical Billing

6 Strategies to Make Getting Paid Easier as a Healthcare Professional

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As a doctor, you know full well that many of your patients struggle to pay their bills on time. You’ve taken several steps to increase collection of payments due across your practice, but unfortunately, sometimes, it feels as though you’re getting nowhere! You need to keep the lights on in your practice, pay your staff, and ensure that your own paycheck is taken care of, so how do you convince your patients to pay their bills? These six key strategies will make it easier to collect on medical bills.     

1. Let Patients Know What It’s Going to Cost

Medical bills aren’t always expected, but many procedures can be prepared for ahead of time. In many cases, preparing patients for the cost of those bills will allow them to budget or even to put off a procedure that might not be necessary until they’re able to cover the cost. Be honest: check with the patient’s insurance, see whether or not they’ve met their deductible for the year yet, and make sure you’re including all the costs that go along with the procedure.

2. Collect Upfront

Before you see your patients, go ahead and collect copays, deductibles, and other key amounts for them. Train your front desk staff to insist on this payment before patients are able to come back into the office. If they offer an excuse instead of a form of payment, train your staff that, unless it’s an emergency appointment, their appointment should be rescheduled.

3. Create Options for Payment

Allowing patients to use a payment schedule to pay off medical debt is a great way to keep bringing those payments into your practice even when your patients are struggling to come up with the extra money. By offering solid payment schedules, especially if you offer emergency services or services that are needed quickly, you help create a better rapport with your patients and let them know that you’re willing to work with them. Offering payment plans when you contact them is also a great way to get patients to start paying on an old debt.

  1. Mention Debt When You Connect

Do you have patients who are in your office on a regular basis–and who are steadily incurring more medical debt? What about patients who are due for their next annual appointment, but still haven’t paid for last year’s? When you connect with your patients through appointment reminders, annual visit reminders, and other means, make sure that you mention the unpaid bills. In some cases, your patients may have simply forgotten about them completely!

  1. Use a New Method of Connection

If you urgently need to get in touch with a patient, how do you do it? While bill collection might not be urgent, it is necessary–and simply sending a letter every 30 days may not be the incentive patients need. Instead, when accounts reach a certain number of days past due, go ahead and connect with patients over the phone or by email. This is especially helpful if you offer them the ability to make a payment, pay the bill in full, or even set up regular withdrawals from their account right from where they are, rather than forcing them to remember to do something later.

  1. Use Effective Revenue Cycle Management

You need to concentrate on seeing your patients, and your office staff has plenty of other things to occupy their time. By working with a revenue management company, you can increase the odds that patients will take care of their bills on time without substantially increasing the efforts of your staff.

There are times when you’ll feel as though getting patients to pay their bills is the most difficult part of your job. Fortunately, we’re here to help. If you need help getting your patients to pay their bills on time, contact us today to learn how we can partner with your practice to ensure more effective revenue management.

Topics: Healthcare ConsultingMedical BillingAccounts Recievable Management,ClaimsHealthcare Payments