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Typical Mistakes in Medical Billing & Coding

Medical billing and coding are critical components of healthcare, yet errors happen every day. To minimize the risks of accuracy-related issues and ensure proper reimbursement for services rendered, it's essential to be aware of the most common mistakes made by both providers and payers. This guide will discuss how to identify and avoid these errors when dealing with medical billing and coding.

Using Incorrect Codes

One of the most common mistakes made in medical billing and coding is using incorrect codes. This can happen for a variety of reasons, such as a poor understanding of the coding system or an inability to identify the correct procedure code. Errors can also occur when providers make assumptions about the accuracy of pre-filled codes or use outdated codes that are no longer in effect. To avoid these mistakes, be sure to familiarize yourself with the current ICD-10 and CPT guidelines.

Entering Wrong Patient Information

Entering the wrong patient information by accident is another major mistake made in medical billing and coding. This could be as simple as typing a wrong name or address or as serious as entering billing information for the wrong patient altogether. To avoid this error, double-check your entries before submitting them and take extra care when entering patient demographics. Additionally, it's important to keep up with changing regulations which often dictate how patient data must be stored and shared.

Mishandling Insurance and Payment Information

Another common mistake in medical billing and coding is mishandling insurance and payment information. It’s important to understand the details explaining how different insurance plans work and what services are covered by a particular plan. Furthermore, familiarizing yourself with websites and payment portals to submit insurance claims electronically can save time for you and your patients. Additionally, properly submitting claims for coverage can help avoid delays in payment which could lead to financial hardship for both parties involved.

Ignoring Fee Schedules and Other Reimbursement Rules

Ignoring fee schedules and other reimbursement rules is a serious mistake to avoid in medical billing and coding. Different insurance plans feature different levels of coverage for certain services, as stated in their fee schedules. Ignoring the fees could lead to under servicing a patient or not giving an accurate representation of the costs that might be incurred. Additionally, many insurance companies are beginning to utilize the Prospective Payment System (PPS), where the payment for each procedure changes depending on complexity and risk. It’s important to remain up-to-date with these changing fee schedules in order to ensure proper billing.

Misclassifying the Type of Service Rendered

Another costly mistake to avoid in medical billing and coding is misclassifying the type of service that was rendered. As there are so many different codes for different procedures and treatments, the wrong code could lead to a reduction or rejection of reimbursement from insurance companies. Even if you think you have chosen the right code, it is always important to double-check with your practice’s administrator and/or billing department before final submission.

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