Medical Coding Mistakes

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	Medical Coding Mistakes

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Mistakes in medical insurance billing and coding can be frustrating. Health care providers depend on their reputation. When billing mistakes occur they will lead to complications, frustrations and often serious complaints! Needless to say, medical coding and billing mistakes are best avoided from happening in the first place because of the interruption in cash flow and income, and possible damages to the business's reputation.

Addressing the Issues

Unfortunately medical billing and collection problems on behalf of the physician's office, or outsourced medical billing services are not uncommon. They usually happen as a result of oversight, error, or in some cases, as a result of incompetence, or fraud.

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Medical Coding and Billing:

Medical Coding Certification

Medical Coding and Billing Mistakes Can be Costly

What Are Some Mistakes Best Avoided From The Start?

Billing patients, health insurances and Medicare/Medicaid for medical services involves a complex system of numerical codes for various diagnoses and procedures. Reimbursement is based on coordinating and properly submitting those codes. Cash flow and financial success depends on proper reimbursement. Rejected claims can be costly and frustrating!

List of Medical Coding and Billing Mistakes to Avoid:

Confusing and indecipherable bills Failure to follow consistent billing cycle Failure to credit payments Failure to deduct payments from balance owed Failure to obtain pre-approval or pre-certification Failure to obtain supplemental or spouse insurance information Finance charges on billing mistakes, or improper finance charges Improper filing of insurance, or failure to file insurance Denial of care due to outstanding balance, even when balance is in dispute Denial of care to patients with "pre-paid" coverage, such as HMO members Denial of care to children of parents with outstanding balances Demanding payment in full from patients with previous bankruptcy filed against provider, even when patient has current health coverage Excessive rates for services; fees above the "usual and customary" Omitted, or wrong modifiers Resurrecting very old medical bills, from years ago Having an outdated patient insurance card on file Coercive and intimidating collection practices by accounts receivable representative		Failure to honor payment agreements made with patients Unwillingness to put payment agreements in writing Improper notification to consumers that their accounts have been "flagged" for no service Refusing requests for information and/or clarification of bills Charges for services never received Confusing a consultation with a referral Sending bills to inappropriate address or person Adding finance charges to Medicare patients Forcing consumers with outstanding balances to get treatment at facilities in other counties Pushing consumers to use credit cards or take out bank loans in order to pay medical bills in full Charging HMO members improperly by calculating a member's 20% co-pay based on the standard price, rather than on the HMO's discounted price Not understanding how patients reach their deductible, and what portion of the payment goes to the deductible Undercoding, charging less Overcharges, double-billing Upcoding—billing for more complicated procedure than was performed
Read: When Hardball Tactics Go Too Far		Read: Upcoding Fines

Diligent Follow-up

Upon discovering improper payments, billing mistakes, or alleged misconduct, all pending issues must be addressed as competently and as quickly as possible. The sooner these issues are dealt with and resolved, the better, to avoid unnecessary (further) reimbursement delays, or possible practical, possible legal issues.

Compliance

The Federal Government OIG has always made tremendous efforts to engage the health care community and providers in combating fraud and abuse. OIG publishes compliance program guidelines to provide hospital industry, home health agencies, clinical laboratories, and now, third-party medical billing clear guidance to effectively monitor and adhere to applicable statutes, regulations, and program requirements. Download the OIG's Fraud Prevention & Compliance Guidelines here.