8 Common Medical Billing Errors

Billing is never an enjoyable process. For anyone. On average, 40 percent of small businesses are 60-plus days delinquent on at least a third of their receivables – and unclear or incorrect invoices can certainly be at fault.

In the medical field, reports say that upward of 80% of invoices are overcharging patients. To ensure you’re not making errors and overcharging your patients, keep in mind the following tips (or share these tips with them and build further trust):

1. Double charging:

Whether you refer to it has double charging or duplicate billing, this error occurs when patients are billed more than once. Human error is the most common example, say, through a doctor and nurse not fully communicating to each other that a particular medication was given – thus a bill could be incurred when the medication was prescribed and administered.

Another common example is billing multiple “first days” in a hospital, which often cost more than subsequent days during a hospital stay. Patients should always carefully read through invoices,  as double charging is the most common reason for unexpectedly higher medical bills. To combat this issue, insure your patients receive an itemized bill, making it easier to spot duplicate charges.

2. Upcoding or mismatched codes:

Upcoding occurs when a medical billing code is improperly changed to one which represents a more severe diagnosis or treatment. While the most common occurrences include things like coding a regular checkup as inpatient care or coding for name-brand versus generic medication, the error of upcoding is still a serious offense. To your patients, it’s basically like getting billed for an expensive bottle of Advil instead generic Acetemenophin….but much worse. And highly illegal. Patients should ask their healthcare providers to correct the charge immediately.

Mismatched codes are another similar error. When a medical bill upcodes your diagnosis, but a patient’s treatment code is left alone, the insurance company will typically reject the patient’s claim due to the mismatch between the treatment and diagnosis codes. This is a double whammy; not only will a patient’s bill be more expensive, but the claim will also get rejected.

3. Unbundling:

Unbundling is the separation of charges that are normally charged under the same billing code. Instead of receiving a package rate for, say, multiple tests of the same code, patients who experience unbundling on their medical bill can often pay multiples of their original bill.  This type of mistake can be tricky to identify, and patients who experience unbundling should reach out to the National Correct Coding Initiative by the Centers for Medicare and Medicaid Services for further advice on arguing the charges.

4. Incorrect quantity:

This mistake could be as simple as an extra “0” placed at the end of a number. Patients should carefully check quantity to make sure they weren’t charged extra for an incorrect amount of items or medications. Talk about a headache for the patient.

5. Incorrect info:

Another of the most common billing errors are simple misspellings and misprints, including incorrect names or policy numbers. Claim denials or being bill for a full amount can occur because of a simple incorrect insurance ID number. Talk about a headache.

The main reason these errors occur are because of how many hands influence a medical bill – sometimes up to a dozen people have something to do with it. One mistake entering incorrect information can be passed down the line just like the childhood “telephone” game, causing severe problems when a patient’s claim is submitted to their insurance company.

6. Balance billing:

Balance billing occurs when a health care provider bills the patient for charges other than co-pays or any other amount than what was negotiated with the insurance company. Balance billing is most common when a patient is treated “out-of-network” for non-emergency care, as doctors can set the rate to charge the patient and bill them for anything over the agreed amount. 

Patients should check with their insurance company about whether or not all of the hospital’s charges are covered under their policy. If they are, then this balance bill is illegal, and patients should not have to pay for it.

7. Overcharge time:

After undergoing a procedure, patients should check medical records to confirm how long they were in the operating room or under anesthesia. Patients are usually billed in 15-minute increments, therefore, mistakes can add up quickly.

8. Canceled procedures:

Patients can sometimes accidentally be charged for a test or procedure that ended up being canceled. They should make sure this doesn’t happen by carefully reviewing their itemized medical bill. If a patient thinks they were wrongfully over-billed, they should collect all the necessary documents to prove they did not receive the service, thus disputing the charge.

Related: How Do I Fix Medical Bill Errors?
redaway medical waste

7 Essentials for Effective Medical Office Managers

Running an office isn’t a job built for anyone. It takes patience, attentiveness, hard work, and delegatory skills to name a few. Being a medical office manager requires all these traits and more.

To be an effective medical office manager, one must pay close attention to his or her staff, keeping in constant communication and understanding the importance every employee serves. Listed below are seven essentials for effective management in a medical office or private practice. Leaving out duties such as invoicing and payments, this comprehensive list will give you, the medical office manager, a better understanding of how to run an office efficiently between you, your staff, and a constant influx of patients.

#1: Communicate Effectively

Communication is essential in every office. For medical office managers, being able to communicate effectively is more than just talking and listening. Effective communication requires the office manager to set the tone for mutual respect between staff and management. Establish employee expectations, as well as providing feedback on said expectations, is essential for every manager. Likewise, you must also be able to communicate effectively through listening. Listen to what your employees have to say about their roles; they understand firsthand their job functions better than you do. Clear communication with employees will allow you to better understand ideas for operating your office more efficiently.

#2: Know Every Job Function

Effective medical office managers understand that every single job role contributes to the overall success of the organization. Understanding each employee’s role is essential for training, managing and motivation purposes. Managers must smoothly operate their office through distributing workloads and supervising their staff. Furthermore, it is vital for a manager to understand every job function on a broad scope so as to understand company goals and staying fully compliant with state and federal requirements. The medical office manager is ultimately responsible for the success of the entire staff.

#3: Utilize A Good Medical Scheduling Software

The use of a good scheduling software will make the world of difference for you as an effective medical office manager. Such software will allow for the quick and efficient scheduling of patient appointments online, therefore cutting down on calls and wait times, as well as free up your time for other important management tasks. Additionally, as in many practices, assigning a relatively low-paid employee to schedule appointments manually will no longer be necessary. Remember: the less time it takes to schedule and see patients, the more appointments your office will receive.

#4: Improve Patient Flow

Following Essential #3, the goal of every practice is efficient scheduling, regardless of the patient mix. The main focus here is to provide care to as large a community of patients as possible, but without taking away from individual patients or compromising their care. Many practices can get by with seeing a patient every 20 minutes. However, others, such as most family physicians, can average four visits or fewer per hour. Avoid schedule gaps, and stay on schedule.

#5: Be Mindful of Staffing Capacity and New Hires

The interview process is rarely a fun time for office managers. But when you find yourself in the situation, be mindful of the person you are hiring. A poor performing employee or problem staff person can easily cause an unbalance in workload distribution, raise costs, and even sometimes lead to wrongful termination actions. Thoroughly establish the skills, objectives and goals, and personalities of every potential employee before hiring, and continue to clearly communicate expectations and hold them accountable after hiring.

#6: Track Office Performance

Track and benchmark data to improve your medical practice’s performance. Several tools are available to help you manage and monitor office operations, as well as benchmark them against the performance of similar private practices. Understanding the data and tracking performance are essential for not only keeping a steady stream of patients, but realizing the efficiency of your staff, through the tracking of such statistics as average patients per hour and patient turnover rates.

#7: Establish an Incentive System

A vested staff is most worthwhile to you in the long run as an office manager. Establish a good, simple incentive system for ambitions employees. Make it a primary objective to compensate your employees notably when they meet certain production goals. Such a system will lead to better teamwork, more positive financial outcomes and increased efficiency. Remember: always clearly communicate your expectations, provide training where needed, justly reward performance, and provide fair base salaries based on experience.