5 Medical Billing Mistakes That The Most Profitable Practices Avoid

Avoiding all medical billing errors may be impossible — especially in busy offices where details can get lost in the shuffle. However, by focusing on stopping the most common medical billing mistakes, you can make the most of your staff’s time and maximize practice revenue.

Medical billing experts Alice Scott and Michele Redmond identify common billing and coding errors — and explain how the most profitable practices prevent them.

Mistake #1: Not using a system for filing claims in a timely manner

Without an effective plan to keep billing running on time, it can get pushed aside. Filing claims on schedule remains essential. Most payers maintain a timely filing limit, and some are as little as 30 days from the date of service. Miss that deadline and the claim may be denied for timely filing.

In that case, appealing that denial as close to the service date as possible improves your chances for collecting. Filing claims in a timely manner becomes key to keeping good cash flow.

Mistake #2: Not understanding how to read an EOB

It takes some experience to interpret explanation of benefit forms and understand what was paid, why a claim wasn’t paid or if it was paid correctly.  The insurer might deny payment or pay only part of a claim. When payment comes in less than expected, read the EOB carefully and figure out the best strategy to resubmit the claim for proper payment.

Simply accepting an initial check from the insurance company as full payment without checking can be a huge mistake. Better to confirm the insurer reimbursed for all the codes correctly.

Mistake #3: Not running aging reports or following up on claims

Some medical offices do not follow up on outstanding insurance claims, and these practices can leave a huge amount of money behind.

Checking claims should remain a continuous process. Staff should proactively monitor aging reports to identify ignored claims that need attention. Some practices don’t run aging reports – they just notice when payments don’t come in, then check on them. Those practices are losing money to claims that never get to the insurance company, claims that get denied but notice of the denial is never received, and checks that never make it to the doctor’s checking account.  It can amount to a serious sum of money.

Mistake #4: Not reviewing clearinghouse reports

On busy days in a billing office, it can be challenging to find the time to look at the clearinghouse reports, especially when unread reports start to accumulate.  But if you don’t take the time to read these reports, you won’t find problem claims that require attention.

Speaking of time, the longer you wait, the less likely those problem claims will get paid.  Fix and resubmit them right away.

Mistake #5: Not making the billing the most important job in the office… for the biller

Believe it or not, in some offices the biller gets assigned so many other responsibilities that medical billing gets pushed to the bottom of the pile.

After treating patients, billing should be the second most important job in your practice.  After all, billing brings in revenue and provides the cash flow to keep your office running smoothly. The billing must be considered the most important job in the office – at least to the biller. Billing is an intricate process that must be handled properly to ensure that an office runs efficiently. By simply identifying which of these common medical billing errors affect your practice and putting systems in place to correct any problems, an office can greatly improve its cash flow.

Make sure your billing system runs the best it can. It is worth the effort to eliminate many headaches and stress.

Alice Scott and Michele Redmond contributed to this post.


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