Common Medical Billing and Coding Errors

Hospital medical claim denials increased by 20% midway through 2020. COVID-19 hospitalizations are attributed to much of that. But medical billing problems were on a steady rise for years before the pandemic.

Whether done intentionally or not, medical billing errors plague providers. They cause a delay or denial of claims, costing many providers up to $15,000. And the medical billing problems often originate at the medical coder’s desk.

There’s no way this article could address the myriad of medical billing issues to date. But for starters, here’s a list of common medical billing and coding errors.

Incorrect or Missing Data

A missing or incorrect data entry on a medical claim could cause billing issues. So many times coders forget to key in a date, often the data of an accident or medical visit. These items may seem insignificant to some. But in the medical billing and coding field, complete data is critical.

And even if a medical coder keys in all required fields, it’s possible the information is incorrect. They may misspell the patient’s name or enter a date of birth that’s off by one digit. Or maybe input the wrong insurance information. Medical claims with the most innocent mistakes get denied.

Invalid Codes Used

The Healthcare Common Procedure Coding System and Current Procedural Terminology sounds complicated. And the diagnosis and procedure codes update every year. So, it’s best if coders use software that’s updated just as often or keep an updated list of codes handy.

Entering a new medical claim containing invalid codes results in immediate denial. To avoid billing errors, it’s best coders double-check their work before submitting it.

Upcoding

When patients receive medical attention, providers should only bill for related services. But oftentimes medical coders enter unrelated treatment codes for more expensive services. This is called upcoding and it’s unethical and illegal.

Fraudulent upcoding occurs often and costs health insurance companies millions of dollars. In turn, health insurance premiums increase, affecting the consumer’s price for healthcare. Companies like Med USA offer outsourced billing services to reduce medical coding and billing errors.

Untimely Claim Filing

Not only is it important to ensure accurate medical claim data. It’s also important the claim gets filed on time. Providers must submit medical claims within 12 months of the date of service. A claim received for processing after the 12-month deadline will get denied.

And notice, it’s when the claim’s received that matters, not when it’s submitted.

Medical Billing and Coding Issues

Medical billing and coding professionals go through extensive training on the claims submission process. But no matter how well they think they know the system, coders often make data entry errors. Common medical billing errors are unfortunate and could prove costly for health providers.

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