Medicare Billing is a very complicated and intimidating task. Even the smallest of mistakes may result in big problems in the form of failures of payment, claim denials, or even legal implications. To navigate smoothly and avoid most of the common pitfalls in Medicare billing, it is important to understand the process.
In this blog post, seven of the most common errors in medicare bills are outlined, with some down-to-earth advice on how you can avoid them.
Mistaken Patient Identity
Probably the most common error in Medicare billing is misspellings of patient information. It is pretty easy to mistype a patient’s name, date of birth, or Medicare number, but each of these physicians can delay or reject a claim.
How to Avoid It:
Always double-check any information relating to the patient before making a submission for a claim. Establish a system in which information can be verified by another team member. If the information is drawn from electronically stored records, make sure that the software is updated and accurate.
Coding Errors
On the other hand, Medicare is largely dependent on good coding for processing claims. Incorrect diagnosis or procedure code might lead to claim denials, or claims might even be underpaid. Unfortunately, coding errors are rampant, especially in cases that are complex or involve patients with multiple conditions.
How to Prevent This:
Invest in regular coding training for your coding staff to nature them with changes in coding guidelines. Use of coding software where there are built-in checks and alerts for some common errors can also be useful. If you have doubts about certain code, it is good to look for professional coding personnel or even refer to the source directly from Medicare.
Missing Documentation
Medicare seeks to find specific documentation to support services that are billed. If a record is missing supporting documentation—the proof of medical necessity—the claim would just be denied.
How not to do it:
Construct a list of documentation that will be required for every service or procedure. Ensure that your practice is educated on the required documentation for Medicare. Maybe audit claims, at least periodically, so you have a good understanding of where gaps may potentially exist in documentation.
Failure to Meet Timely Filing Deadlines
Missed deadlines by Medicare could be missed opportunities for reimbursement. It typically involves missing one claim or the other due to claims running behind the administrative backlog.
How to Prevent This:
Implement a tracking system in which your team is notified as a deadline is approaching. Assign responsible staff members to track electronically and ensure proper and timely claim submission present. It is recommended to get into the habit of submitting claims timeously, immediately after services have been rendered, and also not wait until there is lots of excitement regarding last-minute submissions that can sometimes be expensive due to costly oversights.
Double Billing
Duplicate billings are one and the same service billed more than once. It could be that from a system glitch to staff error, and sometimes it would ring red alerts with Medicare, leading to audits, or worst, cases of fraud.
How to Prevent This:
Review all claims, before submission, for any such claims that have already been billed. Set up a matching process in your billing system that will make the system alert you to any recurring charges which occur as a result of double claims. Periodically review your billing data and cross-check the records to pick any unintentional charges of duality.
Misplaced Modifiers
Modifiers are used to indicate details on the services. However, using a wrong modifier or when to be used and is not, can deny a claim.
SUMMARY : Receiving a message that conflicts
Have your billing persons well educated on when and how to utilize the modifiers. This is part of the duty of the reference guide or “cheat sheet” you will want to create making clear each modifier and when to use them. Continuously spot check denial to see if this might be a recurring issue.
Overbill or Underbill
Overbilling can also be termed as billing for a higher lot of activity compared to what was done, whereas underbilling means not billing all the services that were done. Both practices may lead to severe problems with Medicare, including audits, fines provided in court, and, more seriously, accusation of fraud.
How You Can Avoid It
All claims should be reviewed stringently so that they correspond perfectly, with no exceptions, to the services provided. Use a billing system that makes it easy for the services offered to match the right claim code. The team should be very knowledgeable on the importance of proper billing, which includes the possible risks that are run in case of overbilling and underbilling.
Real-World Example:
How We Improved Our Medicare Billing Process
We used to have quite a run for our money in the clinic with coding errors; they led to our claims being denied and even some slight cash flow problems. It took an internal review after my inheritance to reveal that most of those missed codes.
This has been a learning experience for us, that we have to move with updates about the current billing procedures. This is a lesson that we take into our business transactions.
Conclusion:
Stay Away from Those Medicare Billing Pitfalls Provide me with the right knowledge and tools to prevent Medicare billing from being a source of stress. Be aware of these common mistakes with Medicare billing; take steps proactively to avoid these mistakes and maintain a smooth billing process, one that ensures a healthy revenue cycle.
Remember that accuracy is primary whether it be the patient’s information, codes, or included required documentation; all of the little steps add to the content.
