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Medical Billing Errors Are Seriously Hurting Healthcare

Medical billing is an integral part of any practice, whether patients are using insurance or are paying their bills out of pocket. Medical care is also expensive, and it’s becoming increasingly difficult for patients to pay their bills.

Experts observed a 13 percent increase in medical costs and also found that more than 51 percent of patients owe $1,000 or more to their doctors.

Medical billing errors aren’t just bad for patients, though — they can be detrimental to medical practices, as well. What kind of problems can medical billing cause and what steps can medical practices take to ensure the accuracy of their billing department?

Problems With Patient Care

The problems with medical billing errors aren’t just clerical — they can negatively impact a patient’s care, too.

Most patient billing errors happen due to technology or a staff member entering an incorrect diagnostic code onto the bill. This becomes more common on bills that total more than $10,000 or more. According to credit agency Equifax, those bills often come with errors totaling more than $1300.

Many of these mistakes are honest — a diagnostic code for an exam of both limbs when only one was examined, or a typo that results in a different and more expensive diagnostic code than the one that was prescribed.

The problem is that these errors can result in patients’ insurance companies rejecting their claims, making it more difficult for them to get the care that they need and lowering the overall quality of patient care.

Fraud Charges

As we’ve said above, patients aren’t the only ones at risk when it comes to medical billing errors — they can put practices, as risk as well. Frequent medical billing mistakes can trigger investigations and billing audits that can be damaging both financially and to a practice’s reputation.

Large numbers of billing errors can even result in charges of fraud that can cost a lot in fines and drive patients away from practices.

This is more common than most people think. Roughly 80 percent of all medical bills contain billing errors, which increases the chances that the patient’s insurance company will reject the claim.

Incorrect information the patient provides, such as their name and identifying information, their provider or insurance information all fall under the blanket of medical billing errors, too.

Incomplete or poor documentation on the part of the provider, or a missing explanation of benefits can also contribute to the large number of medical bills appearing in practices across the country.


What can practices do to reduce the number of medical billing errors that appear in their records? Here are a few ideas:

Avoid non-specific diagnostic codes and incorrect modifiers

Don’t upcode or undercode — ensure that all codes are accurate. Don’t add additional codes for expensive procedures or omit codes with less expensive ones.

Check, double-check and check all medical bills again before submitting them to ensure there aren’t any errors.

If a company rejects a claim, it’s likely because they found an error. Handle these issues quickly and double-check the bill before resubmitting it.

Pay attention to medical billing changes. The regulations and laws concerning medical billing change frequently, so it is essential to stay on top of these changes to ensure you aren’t submitting any inadvertently incorrect bills.

Medical billing is an integral part of medical practices, but it’s essential to ensure you’re submitting these bills accurately and promptly. This way, patients can request or make any necessary arrangements to make sure they can pay these bills.

Any errors the insurance companies detect should be dealt with as soon as possible. Remember, accuracy is the most critical part of medical billing.


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