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Improving Medical Billing Accuracy For Claims Payment


In order to ensure proper claims payment, medical billing is critical to ensure efficiency. This is because medical billing involves a substantial amount of data from patients. If these records are incorrect, insurance companies may not process the claim correctly, leading to late or nonpayment. Accurate data also ensures proper insurance claim processing and on-time payment. To learn how to improve medical billing accuracy, keep reading. This article outlines the key factors to consider Medical coding classes.

Double billing

It is imperative for organizations to ensure that their medical billing and coding efforts are efficient. A good way to improve these efforts is to hire a medical billing specialist. Such a professional will be able to process claims accurately and efficiently, while also adhering to current health care regulations. To get started, download a free copy of the Complete Guide to Medical Billing Services. It was written by Stephen O’Connor, Director of Brand and Digital Marketing at Advanced Data Systems Corporation.

Intentionally double-billing is prohibited and can result in civil and criminal penalties. A recent case involved a hospital that had billed a genetic ultrasound twice, for instance. In addition to reducing revenue, double-billing can also harm patient relationships. This article discusses some of the steps that can be taken to avoid this problem. While it may seem inconsequential, the consequences of mishandling your billing records can be significant.

Coding errors

Over 50% of claims are denied due to coding errors. In addition to losses in revenue, incorrect coding can lead to HIPAA violations, legal lawsuits, and hefty federal fines. Most importantly, coding errors are costly for healthcare providers. Not only are claims not paid in a timely manner, but resubmitting denied claims requires time and effort, and insurance providers can only make partial payments.

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Another popular cause for claim denials is inaccurate or missing information. Even a simple slip of the finger can delay payment and cause valuable time to be wasted. To minimize these costs, proper training is essential. Using the most up-to-date reference resources reduces the risk of reworked claims. Lastly, quality control measures help to ensure that the final script is error-free and compliant.

Upcoding

Upcoding is the process of charging for services that are not actually rendered, such as a simple X-ray or anesthesia. The billing staff sometimes makes a mistake, interpreting physician information incorrectly or using an incorrect code. Upcoding can result in denials or penalties for the practice. In addition to claims denials, upcoding can result in practice audits and penalties. Here are a few examples of upcoding that can cause major problems for your claims payments.

For private insurance companies, calling a customer service line can help you report possible fraud. Medicaid payers can contact their state Medicaid office for information on reporting fraud. If the fraud involves Medicare, contact the Medicare program to learn how to file a complaint. In some cases, upcoding has been caught in hospitals and has resulted in the jailing of administrators. But a skilled upcoder can hide behind bureaucracy and systemic malfunctions to get away with the fraud.

Duplicate bills

There are many reasons why your medical billing bill may be incorrect. It could be a result of data entry error, fraudulent reporting, or improper diagnosis. In addition, identifying information may not match, and this could lead to discrepancies between claims and insurance coverage. These issues can have serious financial consequences. To avoid them, ask your billing service provider to review the original claims and ensure they have been processed correctly.

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The Centers for Medicare and Medicaid Services (CMS) defines a duplicate claim as two claims for the same service, date, and beneficiary. The reason for the duplication is unclear, but CMS states that it will reject the duplicate claims when they have the same beneficiary and CPT codes. If the claim is rejected due to a duplicate code, it may have the same patient or provider information and should be paid.

Electronic health record (EHR) software

Electronic health records, or EHRs, help medical coding career providers keep track of their patients’ records. But they can also create a dangerous situation, such as encouraging physicians to skip important data or fill out inaccurate information. That’s why many healthcare professionals and insurance companies are working to ensure that claims submitted by providers are as accurate as possible. Here’s how to ensure this:

Use EHR software to improve medical billing accuracy. The software can be used to update patient medical records as well as billing details. This way, errors are avoided. Also, the software reduces the need for human error, such as manually entering data. By the end of the day, medical billing accuracy can increase profits for both providers and payers. To increase medical billing accuracy, implement EHR software for your practice.

Human error

It is important for medical billing professionals to know the latest trends in coding and procedures. As new codes are added to the medical code set, it is imperative that medical billers keep up to date on the latest trends. Additionally, it is crucial to double check any work when creating a claim, as simple errors can lead to claims that are not paid or approved. For these reasons, it is vital for medical billing professionals to keep up with the latest laws and regulations to avoid mistakes.

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Inaccurate coding: This type of error often results in denied claims. Oftentimes, it is not even noticed by the billing clerk, because the same medical procedure or treatment is listed twice on the patient’s record. Another type of error is upcoding, which occurs when codes do not properly reflect the scope of work performed by the physician. Undercoding results in a loss of revenue for the physician.


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