Common Medical Billing Errors and How to Avoid Them

Claims pricing mistakes can be easy to make without the right technical support, and can cost your organization a pretty penny. Providers are up against increasing risk of financial consequences as medical billing continues to evolve. Small errors alone can lead to denied claims, compliance scrutiny, or delayed payments. These little errors add up to a huge financial loss! With complicated payer requirements, quick code updates, and high patient volumes, common mistakes continue to multiply. If you work in revenue cycle management, it's vital to watch out for common billing and claims mistakes. Let’s look into some of the most common claims pricing mistakes made in today’s healthcare marketplace. Common medical billing errors that can lead to claim denial:

📝 Incorrect Patient Information

Even a simple error in claim submission like a misspelled name, incorrect date of birth, or outdated insurance information can lead to denied or delayed payments. 10% of denied claims result from the patient intake process. There’s simply so much data to give; it's easy for patients to make small mistakes. This makes patient information one of the leading reasons a claim is denied.

🧾 Coding Errors

Denials can also be triggered by incorrect coding. This can come from CPT or ICD codes, out-of-date code books, or missing modifiers. Coding errors are serious and can lead to accusations of upcoding if caught. As new services and coding guidelines are always being added, staff must regularly review codes to prevent improper coding.

📄 Incomplete or Missing Documentation

Insurance claims require so much information; it can be easy to leave something out. Claims that are submitted without important clinical details, admission orders, or proof of medical necessity get rejected. This means patients who submit inaccurate or incomplete documentation must go through the process of resubmitting the claim.

🚫 Lack of Prior Authorization with Submitting Claims

When patients receive services without prior approval and then try to submit claims, their reimbursements can be stalled. This can be helped with automated eligibility checks and pre-service checklists.

🔄 Duplicate Billing

Submitting multiple claims for the same service can lead to denials, but worse still, it can trigger audits or fraud investigations.

🔍 Eligibility Errors or Expired Coverage

Forgetting to verify current coverage before care is a common, avoidable reason claims are rejected. Automatic verification can help catch lapsed claims.

❓ Medical Necessity Disputes

If insurance deems the service not medically necessary, claims can be denied. Training healthcare providers to document necessity is crucial for this reason.

💰 Small Claim Errors, High Prices:

Healthcare claim pricing errors cost money and time. With so much at stake, billing services, healthcare organizations, and patients need all the support they can get. Billing isn’t an afterthought; it’s a complex and integral part of the medical process. Avoiding billing mistakes requires great tech, stellar training, and proactive professionals.

⚙️ Reduce Medical Billing Errors with Microdyn

If you’re looking for claims pricing assistance and RCM solutions, Microdyn can help. Microdyn offers precise claims pricing and payment integrity tools. Microdyn goes beyond claims editing, providing automation and payment integrity tools. At Microdyn, hospitals can access new reimbursement models and regulations, reduce manual labor, fight underpayments, and anticipate denials. Use Microdyn for faster claims resolution, more accurate payment, careful compliance, and all-around financial visibility. Request a free trial today!