Medical billing mistakes affect both the physician and the patient.
Physicians, hospitals and patients rely on medical billing and coding departments to furnish accurate claim information to patients' insurance companies. Billing mistakes not only slow down payment turnaround; in some cases, incorrect billing constitutes insurance fraud. Both health care facilities and patients should monitor the explanation of benefits received from insurance companies to determine if billing mistakes have occurred.
Wrong Insurance Identification Number
Having the wrong insurance identification number on a claim causes rejection of the claim by the insurance company. Medical billers avoid this common mistake by double-checking the patient's insurance information before submitting a claim. If a patient notices use of a wrong insurance identification number, he should contact the health care facility with the correct information and ask for a corrected claim to be sent to the insurance company.
Incorrect CPT Code
Responsible for making sure CPT codes correspond to the type of procedures or testing done, the medical coder should double-check a patient's chart to ensure accuracy. Incorrect procedure codes cause rejections or cause insurance companies to pay for incorrect procedures. A patient should check the explanation of benefits to determine if the health care facility billed the wrong procedure. Report any discrepancies to the health care facility and ask that the claim be resubmitted with the correct procedure. The health care facility must return any payment for incorrect procedures to the patient's insurance company.
Incorrect Insurance
Patients often change insurance companies; therefore the admitting staff must make sure the patient's chart contains current insurance information. Incorrect information costs the billing staff time and money to research and determine the correct insurance company to bill. A patients should produce a copy of her current insurance card at each visit and tell the admitting staff if any changes in insurance have occurred.
Incorrect Date of Service
Billing the wrong date for a service constitutes fraud on the part of the hospital or physician. Hospital charges often incorporate several dates of service and several different procedures. The medical biller must compare the patient's chart to the claim to determine if all charges correspond to the date of service. A patient should check the date of service on the explanation of benefits and report any discrepancies to the health care facility. Ask for a corrected claim with the appropriate date of service.
Timely Filing
Most insurance companies require health care facilities submit claims within a certain time frame and failure to do so results in rejection of the claim due to untimely filing. Claims rejected for untimely filing become the responsibility of the provider, causing lost revenue. Monitoring all aging claims and resubmitting them within a timely fashion ensures receiving payment for services rendered. Patients should note any claims rejected for untimely filing to make sure the health care facility does not bill them for services rendered.
Tags: health care, care facility, health care facility, insurance companies, date service, insurance company, explanation benefits
