Common Billing And Coding Mistakes - And How To Avoid Them

Coding and billing mistakes are unpleasant scenarios for all parties involved. For example, patients have to deal with the fact their provider won’t help them resolve the problem. At the same time, for medical facilities, these issues can be destructive as they end up in claim denials.

Since an insurance bill that is chock full of mistakes will be rejected, the claim will take twice as long to get processed. As a result, medical providers have to pull double duty at the expense of actually helping patients.

In other words, insurance billing is the main funding resource of all healthcare providers so billing errors need to be avoided at all costs. 

Continue reading this article to learn all you need to know about common billing errors such as bundling and unbundling medical definition, and how to steer clear of them.

Most Common Mistakes

The main cause behind almost all errors in coding and billing is the inattentiveness of the staff. This is good news because it means being familiar with the mistakes can drastically reduce the chances of them happening. Here are the main offenders:

1. Not verifying insurance

This mistake is very expensive to deal with, and surprisingly, very common. Thankfully, it’s easy to circumvent since it usually happens out of pure routine. For instance, a patient may visit your clinic/practice regularly. Because of this, your staff may simply assume the insurance policy of the patient has remained unchanged and they’ll fail to check the terms. 

This is easily solved by always verifying the insurance for new, as well as loyal patients.

2. Lack of documentation

According to the Social Security Act, Medicare won’t cover unnecessary services. This means they will only cover the services needed to establish a diagnosis or treat an illness.

Thus, sometimes it’s imperative to supply the medical records that support medical necessity. This documentation could include anything from medical history to discharge summaries. Failure to produce these documents typically ends up being seen as if no service has been provided.

3. Missing claim information

On occasion, staff may accidentally leave fields blank. If any field is empty, the insurance company will deny the claim.

Instruct your staff to double-check all fields to ensure nothing is missing and remind them to attach the required documentation. Even if you’ve switched to electronic claim, set up your software so it doesn’t allow the claim to be submitted until all fields have been filled.

4. Lack of detail

Claims need to be coded to a high level of specificity because insurance companies will reject those that lack specific detail. Every diagnosis or procedure has to meet the maximum number of digits for the particular code.

This often happens with untrained staff members who aren’t aware they are making a mistake while coding.

5. Missed deadlines

Even if you file the claim correctly and refrain from making any other errors, your claim will most likely be rejected if you don’t submit it within the requisite timing window. In some cases, even if you submit the claim before the deadline, it will get denied by the insurer if they receive it late. 

Always keep in mind that the period of submission is 12 months. To be on the safe side, send your claims as soon as possible.

6. Typing errors

Precision matters most with coding. But then again, that’s easier said than done as mistakes and typing errors happen all the time. The problem is that the insurers won’t let an incorrect date or a typo in the patient's name slide.

To avoid this slip, always double-check all the data until you’re absolutely sure everything checks out.

7. Not verifying coverage 

Insurance information can change at any time, making it necessary to verify coverage for a treatment time whenever you provide a service. Make sure every medical procedure you did is covered by your patient’s insurance, and also check the status of their coverage. 

8. Using outdated codes

If the codebook your staff is using is outdated, you may end up with bills using the wrong codes. All the treatment codes, along with the diagnosis and treatment have to match. If they don’t, your claim will get denied. 

You and your staff should keep up with the latest changes in medical billing, which is a field that is constantly getting updated with the latest discoveries. For instance, in 2022, many outdated codes for pain management were eliminated and replaced with more detailed ones.

9. Unbundling or bundling medical procedures

These mistakes are quite complex so to understand them better, it’s important to provide an unbundling medical definition. In simple terms, unbundling is a practice of billing multi-step procedures separately instead of billing them as a single procedure. 

A minor procedure is sometimes a component of a bigger procedure. For example, when performing a nasal endoscopy, it’s customary to have to cauterize a nosebleed. Even though there is a separate code for the cauterization of nosebleeds, it shouldn’t be used as in this case, the procedure is already a part of the endoscopy. 

Unbundling medical definition is also often mentioned when discussing billing fraud. Making this mistake can provide a higher reimbursement rate, which is why it’s also a common form of medical billing fraud. 

To stay away from bundling or unbundling, see to it that your coders refer to the relevant coding book to see which procedures they have to bundle.

How to Avoid These Errors?

Making mistakes is easy, which is why it’s imperative to double-check almost everything before filing a claim. That goes for the personal data of the patient, their coverage, the correct codes, etc. 

Everyone in your organization should work together to make certain the billing and coding processes are always smooth and mistake-free. Physicians should work together with the support staff to complete the paperwork before filing anything. 

As an extra line of defense, you can also leverage the services of a clearinghouse. These companies can check your claim for errors and if they find anything, they will send it back so you can make the appropriate corrections. 

A Healthy Revenue System

By decreasing the occurrence of billing and coding errors, you’ll prevent any disruption to your organization’s revenue system. You’ll keep at arm’s length claim denials, loss of revenue, and even criminal liability and expensive federal penalties. 

It all starts with a little bit of patience. Now that you know which mistakes may happen, you can take the necessary precautions to keep away from them.