Medical billing can be complex, time-consuming, and challenging. What can you expect from a system that is constantly in motion and governed by multiple rules? There is plenty of room for errors. To make matters worse, many people may not realize they are making errors. No matter if your billing errors are accidental or deliberate, they can have serious consequences. Medcare MSO Medical Billing Services is an enterprise-grade solution provider that can handle all your revenue cycle management needs.
These include revenue flow disruptions, claim denials, and, worse, reputation damage. It is important to be familiar with the basics of billing before they eat into your bottom line. Let’s now get into the details and understand how practices can misbill.
Medical Billing Services
Over-billing
Overbilling, a tactful tactic to get higher payments, is an intentional tactic. These are the main ways that this can happen:
Up-coding is when practices enter incorrect billing codes for more expensive or extensive services than they actually deliver.
Overcharging: This is similar to up-coding. It occurs when practices charge extra units for services or add codes for services they did not perform.
Utilization abuse: When practices make unnecessary visits or offer inappropriate services, it is called utilization abuse.
How to Avoid It
In most cases, over-billing is intentional. It is therefore essential to have a monitoring system in place to ensure that no patient is overbilling or delivering medically necessary services.
Misbilling
If you have a claim denial rate above 4%, misbilling (which includes manual errors and timing issues, as well as input oversights) could be the cause. This error is usually caused by a practice that fails to meet the following criteria:
- Correct billable codes
- Coding at the highest possible level of specificity
- Clean claims
How to Avoid It
Cleaning up your billing process is the best way to avoid this type of error. The following steps will help you do this:
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Perform an annual internal medical billing audit
Regular internal audits should be conducted. Keep track of every step, from documentation to coding to claims creation. To find the root cause of any denied claim, thoroughly examine it and implement the correct mechanisms to fix it.
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Opt For Billing services Or Services
Services and services for medical billing can help you solve any billing problem, including misbilling. These services can be a great asset to your practice.
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Level-Set Your Team
Interact with your team members on a regular basis to ensure that everyone is on the same page. Discuss the common issues that can hinder operations and how they affect your business. Next, discuss the steps they can take to prevent such problems from happening again. If necessary, be open to the possibility of additional training.
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Examine Every Denied Claim
Recent studies show that fewer than 40% of providers appeal denied claims, which is unacceptable. Many claims are denied because of mistakes made by the payers. Don’t hesitate to examine the reasons behind every claim.
Misbilling and overbilling are not small mistakes. These are rampant problems that are more common than we thought. These mistakes are not something to ignore. Instead of ignoring them, you can make sure they don’t grow out of control and cause your business to go under.
