Medical Billing Errors and Returned Claims

The medical biller intends to provide is right settlement and reimbursement for their services. In tracking down this goal, an error might occur for human beings or a technical hitch. These are, unfortunately, unavoidable. As the medical billing process involves two vital elements: Health and Money, it is very important to minimize the errors as much as possible.

Here, is an introduction to some of the common errors in the medical billing practice. Before the discussion, let us know the differences between a discarded claim and denied claim.

Before we jump into that discussion, however, let’s review the difference between a rejected and denied claim.

A discarded or rejected claim is the one that contains many errors which prevent the insurance company from paying the bill and it is sent back to the biller for correction. The errors may arise from accounting errors, any incompatible process, or ICD Codes errors.

A discarded claim is then sent back to the biller with a request for clarification of the errors that occurred. These claims are resubmitted after modification. Finally, it becomes a “clean” claim.

While the denied claim, that is processed by the payer, remains unpaid for violation of any term and condition between the payer and patient contact or it may contain vital error(s) that were only detected after dealing and processing. Payers will show the reasons for denial when they send back the claim to the biller. This invalidated claim processing takes time to be fixed. So if you don’t want to waste any time, check and recheck any incompatibilities in the documents before you submit them.

Simple Errors

Here are some of the errors that might reject your claim

• Wrong patient information
• Inaccurate provider information
• Erroneous insurance provider information
• Wrong codes
• Mismatched medical codes
• Leaving out codes altogether for procedures or diagnoses
• Duplicate billing

These are some of the most common errors that medical billing personnel encounter. These errors affect the process directly. If you can minimize these simple errors in your medical billing, the possibilities of getting a claim become higher.

But some other errors are out of the biller’s hand, but they are important points to be vigilant. These are:

• Under coding

Under coding comes about when a provider intentionally drops a procedure code from a superbill. Undercoding is done to avoid audits for certain procedures or to try and save money for the patient. This process is not authentic and is treated as a kind of scam.

• Upcoding

Upcoding is also a kind of fake process. Here the providers purposely misrepresent the work they carried out on a patient. In upcoding, the codes are entered, for the services that a patient did not receive. Or it may be more intensive procedures that the provider performed. Upcoding is normally done to get more money from a payer. This, like under coding, is a falsified practice and should be noted and reported right away.

• Poor Documentation

Though not like upcoding or undercoding, insufficient documentation can have a negative effect on the processing of claims.  If a provider gives inaccurate, illegible, or partial documentation of a procedure or patient visit, then it’s difficult to make an accurate or complete claim. In cases of sloppy documentation, the biller should contact the provider and ask for more information.

So error fixing is important for medical billing procedures. Always stay connected and update and be alert to any errors.