What are Some Common Medical Billing Errors?
There major areas where medical billing errors can occur are:
Simple honest mistakes. Medical coding and billing is a very complex and laborious process, and mistakes are unavoidable. For example, examination of a limb can be coded twice, and coding which limb was examined could be mislabeled. Nevertheless, these honest mistakes can still lead to overbilling of patients.
There are many grey areas in interpreting clinical interactions and turning them into procedure codes. A simple procedure like the strep throat example above is relatively straight forward. A trauma in the emergency room is with multiple modalities and physician specialties will be subject to a lot of interpretation during the coding process. These grey areas can lead to upcoding, which is the practice of assigning inaccurate and higher billing code in order to increase reimbursement.
The translation of procedure codes into claims can introduce errors into the process. The medical biller often only has the medical coding report but not the actual chart, as their responsibility is to translate the coding report into a bill. Therefore, the itemized bill itself may not be an accurate reflection of actual services and supplies rendered.
The claims adjudication process at the payer can also introduce errors. The payer may incorrectly reduce or deny valid claims based on their interpretation of benefits and coverage, especially for complex cases.
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