Top 8 Medical Billing Mistakes


It’s the first of the month and inevitably you sit down to the drama of reviewing the financials for the previous month.  Do you handle your medical billing services in house, or do you use a third-party billing company? Either way, the cash flow is lower than it should be and you wonder: Are mistakes being made somewhere? This can’t be right…”

Every medical office has been in this situation at one point or another.  Since the economy is now demanding that more work be done in less time, we tend to accept that “Desperate times call for desperate measures, right?”

 Not true for medical billing.

 Amidst the changes in the medical industry like: 5010, ICD10, SGR, RAC audits, and many more… it is easy to overlook small things we cancontrol.

NeltnerFalconDuring our 25+ year tenure, Neltner Billing and Consulting has had a unique perspective that has allowed us to gain first-hand industry knowledge across a broad client base.  We have learned that many different errors, large or small, can lead to a significant impact on the bottom line.  Below are the most frequent errors we have seen.  We’ll start with the basics and move to the more significant ones.

How do you measure up?

1)    Missing Records of Patient Visits 

An office visit starts with your sign in sheet and your daily appointment scheduler.  Without the two of these working in tandem, there is no way to assure that all visits are captured in your daily reconciliation.  Be especially careful if your making visits in a hospital.

2)    Insurance Verification and Authorization

The lack of proper and timely Insurance verification is a money pit.  Verification is more than copying the patient’s insurance card at the front desk. Having verification of coverage and knowing the extent of benefit are a must.

For example, how often do you verify the order of coverage; primary, secondary or tertiary?

Authorizations are equally important.  The patient’s treatment plan may be covered by their insurance company, but more specifically, by their plan?  Some plans don’t cover office visits. How often do you admit someone and perform a service that isn’t covered?

3)    Missing or Incorrect Procedures; Drug Waste

Accurate and first-hand data capture is imperative.  If the fee ticket does not say …

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4)    Insurance Follow up   

5)    Incorrect _________/_________ Write Offs

6)    Double Check Those _____!

7)    Monitoring ________ Reimbursement Rates

8)    Frequency of ____________  ______________

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If you are experiencing these types of mistakes then you need to take action. 

Start by testing your knowledge and get the complete checklist and descriptions here.  It’s free.

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Author: NeltnerWebTeam