Billing mistakes are inevitable. From having to juggle multiple systems, keeping up with mounting denials and appeals, and navigating the complexities of evolving regulations, even the most careful people will make mistakes. Still, denials and lost revenue due to billing errors add up to huge costs that strain your organization’s revenue — not to mention the downstream impact it can have on your patients.
Whether you’re rethinking some of your RCM strategies or considering a complete overhaul, it’s always important to have a firm understanding of those top billing mistakes and how to fix them.
Billing Mistake: Failing to verify insurance coverage
According to a 2020 report by KFF, 18% of denied claims in 2019 were caused by a lack of plan eligibility, which can be caused by everything from a patient’s plan expiring to a small change in coverage.
Billing Solution
Employ a real-time system for verifying patient eligibility upfront and also prior to submitting each claim for both Medicare and private insurers. This gives you an accurate picture of the patient’s eligibility and benefits, coverage type, deductible info, and provider or service-specific coverage information. If you discover the patient isn’t eligible for coverage upon the date of service, you can discuss payment arrangements with the patient before service is rendered.
Billing Mistake: duplicate billing
Most provider offices move at dizzying speeds, making duplicate billing one of the most common and understandable errors. Duplicate billing may result in a number of undesirable outcomes, not just denied claims and lost revenue, but your organization could be flagged for a fraud investigation.
Billing Solution
Use analytics to leverage your data to identify and understand duplication billing trends within your organization. This helps you pinpoint exactly where your team is making mistakes, giving you more control to set goals and develop a plan to avoid duplicate billing.
Billing Mistake: inaccurate claim information
Another common billing mistake, inaccurate information on a claim (like the wrong social security number, date of birth, or misspelled name, etc.), will likely result in a claim denial. This also includes missing information.
Billing Solution
Train your staff to double-check claims for accuracy and missing information before they submit a claim. Create a culture of high-quality patient data with your registration staff, but don’t set zero-error expectation pressures on your team. People will inevitably make mistakes, so prioritize investing in a dependable system that automatically discovers errors and inaccurate or missing information, which can provide substantial ROI.
Billing Mistake: using wrong or outdated billing codes
If your biller or coder is using an outdated codebook or enters the wrong code, your claim may be denied. And as those denials add up, you will inevitably see a hit to revenue as a result.
Billing Solution
When Medicare and payers release code updates, be sure you’re on top of it. Check on new medical billing protocols and understand how and why they may affect billing. If you’re still manually looking up codes, find automated tools that eliminate this time-consuming task.
From an organizational or departmental level, you can take other steps to streamline your billing and claims management.
1. Create a culture of quality and data integrity
You can achieve this in a number of ways, none more effective than getting staff buy-in. Ask your team to form a task force that analyzes billing trends or develops a chart audit system. Pick one or two data champions in your organization who take responsibility for data integrity and promote a denials prevention mindset.
2. Communicate, communicate, communicate
Medical billing departments must efficiently share information, both internally and from external sources, to ensure everyone is up to date on issues, new regulations, training, and processes.
3. Use automated revenue management and data analytics tools to streamline and modernize your approach
Take advantage of sophisticated automated tools in the marketplace to help you be proactive, avoid mistakes, increase efficiencies, and ultimately get your cash flow going in the right direction. Look into solutions powered by AI and RPA, so you can streamline and automate tasks while taking advantage of predictive analytics for a more in-depth look at your rev cycle.
The wrap-up
Many of the issues we’ve discussed no doubt touch on common areas of concern your billing team is already familiar with. But simply assuming you and your team are aware of these common mistakes will create a cascade of problems in your rev cycle.
Instead, you should take the initiative with a proactive strategy that prioritizes these mistakes with regular and rigorous monitoring and action items. Set up check-ins for you and your team to monitor and assess how the strategy is going, and work to evolve your approach accordingly.
Of course, you don’t have to go it alone. Waystar can turn your most common mistakes into easily managed tasks integrated into daily workflows. Waystar offers a wide variety of tools that let you simplify and unify your revenue cycle, with end-to-end solutions to help your team elevate your approach to RCM and collect more revenue.
