Medical Billing

The Most Frequent Medical Billing Errors That Companies Make

Medical billing errors are prevalent and can happen to any company. They often stem from a lack of understanding of the medical industry or insufficient staff who know how to code properly, especially in the medical billing companies. There are many ways to reduce these errors, but it is important to be proactive before your customers start complaining. At Integrity Billing, we specialize in billing and other healthcare management services. This blog post will discuss the most frequent medical billing errors companies make – some you might be making yourself without even realizing it.

1. Not understanding the medical industry.
This is one of the most common medical billing errors companies make. They may not understand what services are covered by insurance, how to code procedures properly, or what is considered a reimbursable expense. All of this can lead to mistakes when submitting claims and result in lost revenue for your company. However, outsourced medical billing services can help solve this problem.

2. Failure of verification of benefits for insurance.
Another common mistake companies make is failing to verify insurance coverage. Before submitting a claim, it is important to make sure that the patient’s insurance plan covers the service you are providing. If it’s not, you could be on the hook for the full cost of the procedure.

3. Not submitting claims on time.
This medical billing error can often be attributed to a lack of staffing or understanding of how the system works. When claims are not submitted on time, you run the risk of them being denied due to insufficient documentation. And if they are denied, you will have to resubmit them. However, an outsourced medical billing service provider can help solve this mistake.

4. Incorrect coding.
This is one of the most common medical billing errors and can lead to significant financial losses for your company. Incorrect coding can result from not having enough staff familiar with medical coding guidelines, or it could be due to human error. Either way, it is important to have a system to check coded claims before submitting them to ensure accuracy.

5. Not following up on denied claims.
If an insurance company denies a claim, it is important to follow up on it as soon as possible. Often, all you need to do is provide additional documentation, and the claim will be approved. However, if you don’t follow up on denied claims, you could end up losing money.

6. Filing duplicate claims.
This medical billing error often occurs when companies submit duplicate claims for already billed procedures. This can be a costly mistake, leading to claims being denied and additional administrative work.

7. Not verifying patient insurance eligibility.
It is important to verify that the patient is eligible for coverage before providing services. If you provide services to someone who is not covered by their insurance plan, you will be responsible for the full cost of the procedure. Therefore, verification of benefits is essential to ensure the eligibility of patients.

8. Failing to follow up on unpaid bills.
Often, bills go unpaid because patients forget or don’t have the money to pay them. Therefore, it is important to follow up on unpaid bills on time to get paid what you are owed.

These are just some of the most common errors that medical billing companies make. By being aware of these mistakes and taking the necessary steps to avoid them, you can ensure that your medical billing process is as accurate and efficient as possible. If you are looking for more tips on how to improve your medical billing process, contact Integrity Billing.

Why Substance Abuse Billing is Important

Substance addiction is very common throughout the world. But it is not something that should be taken lightly. When people regularly consume “substances” in excessive quantities, they’re called addicts. But substance abuse and addiction are two different things. 

Substance abuse refers to the use of alcohol or any other drug, be it legal or illegal, in large quantities. Substance abuse can be cured with proper rehab facilities. On the other hand, addiction is harder to get rid of. 

Rehab centers and other healthcare facilities help individuals with substance abuse and addiction problems. But these rehab centers also need an income to run properly. To get stable revenue, they need to make proper billing. Even the slightest bit of mistake in billing can cost rehab centers a lot of money. Hiring a substance abuse billing consultant can help. 

Rehab Centers vs. Insurance Companies

There is always an ongoing battle between rehab centers and insurance companies. Generally, rehab centers are paid via insurance money for the patients. A patient rarely pays out of their own pocket. 

But getting the money from insurance companies is no less than a headache. Reimbursement is often very difficult for rehab centers and other similar healthcare services. Moreover, some insurance companies send the reimbursement directly to the patients rather than to the healthcare facility. 

Even when they send the money to the healthcare company, there are many hurdles along the way of receiving money. To start with, insurance companies delay payments without specifying a reason. Furthermore, the billing process is complex. Mistakes in billing can cost rehab centers a lot more than they can earn. Some rehab facilities even ran out of business because of this particular reason. But if you hire a third party for billing, you can get the payments in time. 

Rather than opting for in-house or incompetent third-party billing companies, rehab centers must hire a reliable billing company with in-depth knowledge about billing procedures. Simply knowing the codes isn’t enough to create bills. 

Reasons for Rejected Claims and Delayed Reimbursement

Here are some of the main reasons why insurance companies reject claims or delay reimbursement to rehab facilities: 

False Claims and Caution Against Fraudulent Acts

Many healthcare facilities made false claims to get insurance money in the past. That’s why a lot of insurance providers are cautious of fraudulent claims. This is one of the biggest reasons insurance claims are either rejected, or the reimbursement is delayed. 

But effective billing can help get detox centers and rehab facilities their rightful money in time. 

Lack of In-Depth Knowledge

Another reason for delayed reimbursement is that billers don’t have enough knowledge. This can happen more commonly with in-house billing systems. It’s important to address the receivables of the last 90 days if you want to get your money quickly. 

Lack of knowledge on how to get past money can make it lost forever. But if your third-party billing company knows how to tackle lost money, they might be able to get you your money very easily. 

Reevaluation of Service Providers

Another reason rehab facilities and detox centers fail to get their money is that they don’t bother reevaluating their service providers. Reevaluation will help you understand whether or not a service provider is beneficial to your business. If it’s not, you should seek a new service provider. This is important for regaining your money. But this is one of the most overlooked factors. 

Payments Made to Patients

Many healthcare workers fail to realize that the money would be paid to the client directly. Before you take on a client, it’s important to understand how and who the insurance company will pay the reimbursement. When a rehab facility finds out, there is no way to get the lost money back. Often, many rehab facilities are left with millions of unclaimed dollars. For one reason, these unclaimed dollars remain lost, and rehab facilities fail to recoup the lost money. 

The Bottom Line

The bottom line is to have in-depth knowledge about substance abuse billing. A competent substance abuse billing consultant can guide you and even save your rehab facility from shutting down permanently. 

Some laws have mandated sending the payments to healthcare facilities rather than paying the patients in some states. If you’re not aware of all the codes, regulations, and tactics for getting the payment yourself, you should forget about in-house billing. Instead, you should hire a third-party substance abuse billing company that can do the job for you. 

Get in touch with Integrity Billing by calling (800) 683-5640 or visit Congress Professional II 1630 South Congress Ave., Suite 102, Palm Springs, FL 33461 for further details.