Common Medical Billing and Coding Errors

 

Upcoding

Upcoding occurs when a medical billing code is incorrectly used to reflect a diagnosis or treatment that is more severe. It is imperative that only codes that are supported by the documentation for the visit. Too often upcoding occurs when the physician  “feels” that a service was worthy of a certain code but the documentation is incomplete or does not substantiate the choice of code.

 

Duplicate Billing

Hence its name, duplicate billing means that a patient has been billed for the same service more than once. Duplicate billing may occur when a patient’s appointment is moved but the original slot remains filled in the scheduled and the patient is billed for both times. In some instances, patients may be billed for more than one first day in the hospital, which is typically more expensive than the following days at the same hospital. In each case, having a proper charge tracking mechanism in your EHR or PM system will ensure that duplicate billing does not occur.

 

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Incorrect Patient Information

A claim can be rejected by an insurance company if a patient’s insurance information is incorrect or his or her name is misspelled. Unfortunately, incorrect patient information is a common error between an insurance company and medical organization. Typically these errors lead to a large amount of “back-end” work by your staff and a decrease in profitability for your practice.

 

No Code Linkage

The purpose of code linkage is to prove medical necessity and give insurance companies a reason to pay a medical provider. Code linkage connects a diagnosis code with a procedure code. It is imperative for the diagnosis code to properly match up with the procedure code. A lack of code linkage or code linkage that does not demonstrate medical necessity will prevent a medical practice from getting paid.

 

Digit Transposing

A small error of transposing digits can cost a medical facility. A simple accidental switch between two numbers when entering an ID number can lead to claim denials and severe delays in payment. Transposing of digits often occurs when entering dates of birth and other numerical data.

 

Avoid Common Medical Billing and Coding Errors with Applied Medical Systems

Your medical organization cannot afford serious payment delays because of a medical billing or coding error. To keep a steady stream of reimbursements going and maximize profitability, outsourcing medical billing and coding services is a smart choice. At Applied Medical Systems, we guarantee efficient medical billing and coding solutions so that you never have to worry about a claim denial or delayed payment. Contact us today for more information.