Tuesday, May 21, 2024

5 Most Frequently Occurring Mistakes In Physician Medical Billing Services and How To Avoid Them

Most of the physicians lose a significant amount of revenue every year due to minor and major mistakes that cause errors while filing medical claims. A minor write-off in physician billing services can result in the claim denials and hence no payment. If practitioners don’t implement the right strategies for medical billing and coding then their practice can go down due to the excessive workload caused by excessive claim denials. Since it consumes a lot of time and effort to follow up, revise, and resubmit claims for reimbursements. Only a dedicated resource can keep abreast of all the ongoing happenings with your claims and account receivables. I would recommend you to find more information about physician medical billing services through the given link; medcaremso.com/physician-billing-services

If no one would keep proper a check and balance of ins and outs of physician billing services then several errors would impact your net revenue negatively. There could be a number of reasons that can result in payment denials and ultimately revenue loss. In this article, I have mentioned the top 5 mistakes that usually occur in the physician medical billing services of any healthcare center;

  1. Incorrect or Incomplete Information:

The primary step of physician revenue cycle management is the information collection that may include data about the patient’s name, age, demographics, contact details, social insurance number, etc. Although, it is the easiest part of medical physician medical billing services. However, if not executed properly then it may also become a foundation of a lot of medical billing errors and mistakes. In most cases, if the information is not collected properly (with 100% assurance of accuracy) then it drives claim denials. These types of errors could be resolved by hiring highly trained medical billing specialists that can implement proper strategies to verify the accuracy of the information every time they file a claim. They should also execute this process electronically in order to ensure data security and integrity across the whole network.

  1. Wrong Medical Codes Or Improper Modifiers:

If the medical billers have submitted claims with wrong medical codes or improper modifiers then the payers will definitely reject that claim.  Since it is difficult to get the highest proximity level and for specifying a variation in a medical condition. Therefore, medical coders should acquire the proper training to use the right codes that best describes a medical condition at the highest level of specificity. If appropriate medical codes then it may result in two conditions;


It occurs when a medical biller or coder use CPT code for a more expensive medical service than the actual service received by the patient. It may also occur when the medical billing staff forwards incorrect information to the payer via medical claims.

Therefore, it compels patients to pay more than what they have received during the course of their medical treatment in the physician’s office. It will make patients more responsible of their healthcare expenditures and impact patient-provider relationships negatively. To ensure accuracy in your medical billing and coding services, professionals must use the right medical codes and modifiers and double-check medical claims prior to submission.

  1. Unverified Insurance eligibility Criteria:

It is the primary responsibility of the front desk staff to perform prior authorization and verify the patient’s insurance eligibility criteria in advance to the medical billing process. Otherwise, an unverified insurance plan can become one of the leading reasons of claim denials and rejections. Such kind of medical billing practice can lead to the loss of payment and slows down your financial progress.

Therefore, to streamline your physician medical billing services, your staff must be careful and dedicated enough to stay up-to-date with the insurance information of both_ new and existing patients. Analyze the amount paid by the policyholder, copayments, and keep track of exclusion to keep the track record of effective dates, entire time period of treatment and exclusion of the conditions that are already existing.

If physicians won’t implement the right strategies for physician medical billing services then it would result in the following errors;

Medical Coding Errors:

Sometimes, due to the human-errors or other mistakes in medical coding, the below-listed errors can occur and disrupt physician revenue cycle management such as

  • Using wrong medical codes for diagnostic and therapeutic procedures.
  • Insufficient or incorrect patient information.
  • Incorrect or missing information of all the medical procedures that were performed during the course of medical treatment.

Medical billing specialists should

Avoidance: Reduce human errors by optimizing the medical charting and coding system. Optimization can be done by implementing a suitable and effective Practice Management System.

Over Reporting:

Over reporting refers to a report in an exaggerated manner. It can include the segmentation of a single medical procedure (that can be inclusive of more than one step) and then charging for each segment. This exaggeration is invalid and can cause payment denials.

Avoidance: This problem can be eradicated by formulating a unified method that brings the team into a systematic billing flow. Negligible medical billing and coding errors can result in payment denials when their avoidance is just as easy as to consult a professional medical billing company.

Teodora Torrendo
Teodora Torrendohttps://ccdiscovery.com
Teodora Torrendo is an investigative journalist and is a correspondent for European Union. She is based in Zurich in Switzerland and her field of work include covering human rights violations which take place in the various countries in and outside Europe. She also reports about the political situation in European Union. She has worked with some reputed companies in Europe and is currently contributing to USA News as a freelance journalist. As someone who has a Masters’ degree in Human Rights she also delivers lectures on Intercultural Management to students of Human Rights. She is also an authority on the Arab world politics and their diversity.

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