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The Most Common Billing & Coding Errors And How to Prevent Them

| May 22, 2019

The Most Common Billing & Coding Errors And How to Prevent Them

An error in medical billing is usually something along the lines of data entry or typing errors. The problem is that a mistake in medical billing can make the difference between a payment being made – or not. Simple mistakes are easy to make; a human error has to be allowed for, but lost fees can really drain the finances of a healthcare facility, and it’s up to the medical billers working hard to keep the mistakes to a minimum. Along with this, effective communication can go a long way to ensuring these mistakes are stopped in their tracks before they even become a problem.

Incorrect Procedure Codes

Just one miss of the right key can mean a different procedure is entered as a code in the system. It can also happen if documentation is incorrectly coded before it gets to the medical billing department. If you notice that your practice is receiving claims back more frequently than expected because of the codes being incorrectly input, there’s a chance that your staff isn’t following the right coding rules. Being aware of accurate coding is vital for fewer mistakes.

Mishandled Overpayments

On occasion, claims fails to process correctly because the payer has paid too much or too little. Claims that are underpaid need to be rectified instantly and underpayments should be treated the same. Either side, interest payments should be processed correctly if they are applicable, and if a payer has failed to follow the right procedure, the provider must notify them immediately.

Lack of Data

Problems can happen quickly if diagnosis codes are not correctly linked to the CPT – Current Procedural Terminology – resulting in claim denials or payment delays. This isn’t always a coding employee error, either. If a physician hasn’t provided the proper diagnosis information, this miscommunication can cause the problem. It’s for this reason that it is so crucial for physicians to provide the right codes at all times.

Missing Or Incorrect Information

Omissions are a big reason that claims are denied, and the prevention tool here is straightforward. Double and triple checking all fields before pressing that claim button is the first way to go. Incorrect and seemingly insignificant details left out – names, addresses, sex, insurance information, birth dates, etc. – can cause issues. It doesn’t happen very often, but data from a patient that is entered incorrectly into the system can cause a considerable delay. It’s even been the case that the information is put into the wrong patient record, which means that there is further delay. Billing employees entering the information provided without checking for mismatches can mean for an oversight, and this then ends with a denied claim. It’s an easily overlooked problem when there’s a mismatch because billing departments are often swamped.

Invalid Codes

Sometimes, diagnosis and procedure codes may be input incorrectly because the yearly update has deleted the ones you use most often. Once you bill for the invalid code, the claim is denied instantly. Always, and we mean always, have a list of the updated procedure codes before a claim is made. Check once and then again with the codes listed for the current billing year to help you to prevent making this mistake.


Usually, this occurs when patients end up being billed for more procedures than they received. It can also happen when bills are submitted for procedures that were never performed in the first place. It’s a web of issues when this happens that need to be untangled. If the billing department makes a mistake when entering the treatment codes, or the physician does not provide precise information, upcoding can happen.

Healthcare Tech Errors

While technology is a fantastic addition to the healthcare industry, it can be complicated. The billing process should be as clear cut as possible so that patients receive quality care and a smooth aftercare process. Incorrect use for telehealth services can end with delays in payment, and no one wants to deal with this.

How To Prevent These Errors Occurring

The most important protection against mistakes in medical billing is in the coding process. Medical billers should be as familiar as possible with the medical treatments that they will deal with so that they can recognize codes easily. This includes the new codes that emerge every year on the annual update. Thus, education is vital for the prevention of medical billing errors. A good understanding of medical billing is one thing, but becoming certified is another, and it’s entirely necessary if you want to excel in medical billing and coding. Every hospital and doctor’s office should offer software packages that include reminders and checklists so that you can train and keep up with the appropriate codes; without these, there is more room for error.

Another way to prevent medical billing and coding mistakes is by using a claims clearinghouse. This clearinghouse will check your claim for errors before they get to the right person, and if any are picked up, the claim is sent back to you to fix it. This is something you can do to reduce the number of errors from your office and save any frustration along the way.

Lastly, the best prevention for medical billing and coding errors comes with communication. Physicians have to communicate with patients and nurses to complete the paperwork necessary for the billing department. Additionally, inter-office communication has to be watertight. The front desk must enter information correctly so that it can be cross-referenced with the patient notes to ensure no charges are added onto the bills and no charges are made with the wrong information attached. Doctors and staff should be as well versed in coding rules for it all to run smoothly, reducing the time-consuming errors and reducing costs.

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