Did you know that in 2010, Medicare inappropriately paid $6.7 billion for claims for medical services that were either incorrectly coded or lacked proper documentation, according to the
Error in medical billing and coding is a fact of life. The majority of the errors are explainable due to poor note taking, absent mindedness or poor communication. However, medical billing errors can cost a patient thousands of dollars in incorrect charges. Even if the insurance company is paying the bill, the excess charge can easily be passed to clients. Getting bills correctly invoiced and coded is vital for the medical billing and coding specialist. The role of the medical billing and coding specialist is crucial to make sure the correct procedures have been entered on the records and coded correctly to generate the bill. A patient shouldn’t have to look out for an issue on medical bills or be charged extra out-of-pocket for errors in medical billing.
Some medical billing errors are fraudulent. Whether the error is just incorrect information or a blatant attempt to bill for cancelled procedures, double charge, or upcoding; the medical billing and coding specialist is responsible for not making medical billing error.
Medical bills must be checked thoroughly. A simple error in a date of birth or address can result in incorrect billing charges or the insurance company declining to pay. Even though a patient or relative gave the correct details to the hospital, if it was entered on the records incorrectly by the medical billing and coding specialist, the wrong charges can end up on a bill. If this happens the medical facility may not be properly reimbursed, or the patient has to pay out-of-pocket. Too many medical errors and not enough reimbursements can close a practice. The medical billing and coding specialist plays a big role in keeping a medical practice open and thriving.
If a doctor decides a procedure is unnecessary and cancels it or the patient did not have a test for some reason, this does not mean it automatically disappears from the bill. Medical billing and coding specialists enter procedures onto the records and billing systems but if the test was entered in error or had not been cancelled on the records it can still show on the bill. Usually this is not deliberate but has been done in error and the patient should dispute the bill. It is really important the patient knows what procedures and treatments were completed at the doctor’s office, so they know what to expect on the bill.
Charging for the same procedure twice is another common billing issue. This is caused by the administrative staff entering a 2 in place of a 1. The patient should be able to identify this by the number of tests and whether this matches their experience. Another problem with medical billing is that incorrect numbers of equipment such as dressings and syringes can be charged to a bill. This is important because insurance companies pay out for a set number of items on a monthly basis. If more are charged, the excess winds up with the patient having to pay out-of-pocket.
Upcoding & Unbundling
Sometimes a simple procedure is coded as being more complex on the records. This leads to a bill being generated for a more expensive procedure. It is potentially fraudulent and if unchecked impacts the patient in several ways. Upcoding leads to incorrect diagnoses being recorded and most likely results in a higher insurance premium for the patient. Another common coding problem is when items are charged separately when they should all be bundled as a single procedure. An insurance company is likely to refuse to pay the excess bill and the patient will be left with a large sum of money to find. This can and does cause distress to patients and families.
Trained medical billing and coding specialists are vital in the medical billing process to check the records and ensure the correct information is coded and entered on the medical records. Having trained medical billing and coding specialists in an organization that can identify codes and ensure records are entered correctly improves quality and minimizes the risk of an incorrect bill being issued.
Did learning about spotting a medical billing error interest you? Ready to attend Medical Insurance Billing & Coding program at Meridian College? Medical Billing and Coding professionals are responsible for keeping the records, charts and bills in a medical office in order. In addition to the classroom experiences, students will also complete an externship for on-the-job training that will bring them further expertise. Contact us to learn more about.
Contact Meridian College today to learn more about becoming a medical billing and coding professional.