The healthcare industry relies heavily on medical billers and coders, who send bills to insurance providers, which then pay claims. Errors are bound to happen, especially when working with the thousands of codes a medical biller or coder must know. The International Classification of Diseases, Tenth Revision (ICD-10) was developed by the World Health Organization to classify and code all diagnoses, symptoms, and medical procedures. As a medical coder, the ICD-10 codes you employ make it simple to communicate and compare patient medical information across hospitals, regions, and providers. They also make sure that the billable procedure corresponds to the diagnosis. However, there are a few common medical billing errors that go neglected at times.
Unbundling
Some medical billing codes in hospitals are intended to be used for a collection of treatments that are regularly performed together. Unbundling occurs when certain services are priced separately under different codes. It should be highlighted that unbundling is a prohibited practice because it might inflate a practice’s or center’s revenues, even if it happens by accident. Unbundling can have serious repercussions. Medical billing codes change often to comply with current healthcare legislation, newly-discovered illnesses and ailments, and novel therapies.
It is important to ensure your team has the material they need to stay up to date on all new codes and billing practices. It will save you time, money, and potential legal troubles in the long run, despite the fact that it is time-consuming.
Upcoding
When a code for a far more costly therapy than the one provided is reported to the insurance company, it is known as upcoding. This can happen as a result of an honest mistake, but hospitals and other providers have been discovered doing it on purpose. It’s against the law, and it’s a ruse. In a case involving an injury, an examination of the codes on your medical bills will very certainly be required to decide what is fair and reasonable. One of the first things you should do is double-check that the treatment statement on your Explanation of Benefits corresponds to the therapy you recall getting.
Duplicate Billing
When the same code is entered more than once for the same treatment or operation, it is referred to as duplicate billing. This frequently happens when a claim is re-submitted without being removed from the patient’s account. As a result, every claim’s processing system has a filter that examines each claim received for the possibility of duplication. It’s one of the most common medical billing errors, and it’s most likely just a mistake where someone accidentally entered the same code twice. Nonetheless, it is critical to verify that the therapy provided is accurately represented so that the patient and the insurance company pay the correct amount for the care.
Unsupported Diagnosis Code
Procedures have specific diagnostic codes, and if you select the wrong diagnosis code to receive payment for that procedure, you will be denied. Doctors should identify the Local Coverage Determination (LCD) and insurance rules for the top 10 procedures performed in the practice and prepare a “cheat sheet” for the medical staff. The procedure, each insurance company, and the diagnosis codes covered by those carriers are all included in the “cheat sheet” form. You can quickly determine whether the patient is covered for a procedure before performing it.
At the end of the day, each medical service provider bears a significant amount of responsibility. Aside from ensuring that their patients receive the finest quality medical treatment possible, they must also ensure that their staff and colleagues follow the federal and state government’s billing requirements. That’s where Info Hub Consultancy Services (ICS), an offshore medical billing company based out of India can play an important role in your practice, ensuring you are paid every last dollar and do not lose revenue on common medical billing errors. To help you avoid typical errors and blunders, ICS employs a high-volume professional strategy to medical billing services. We are excellent resources to partner with because we have decades of knowledge and can swiftly and effortlessly repair problems.
