In today’s healthcare industry, medical practices face numerous challenges when optimizing their revenue stream. Internal medicine practices, in particular, have unique billing requirements that require careful attention to detail. Billing mistakes can lead to lost revenue, denied claims, and damaged patient relationships. Eliminating errors is crucial for your bottom line in internal medicine billing. You must identify the most common billing mistakes to prevent them from impacting your revenue cycle management. This blog post will discuss the most common billing mistakes in internal medicine practices.
What Is Internal Medicine Billing?
Internal medicine billing is a specialized medical billing that involves billing and coding for general and family medicine patients. Internal medicine practitioners are often the first point of contact for patients, and they see a high volume of patients each week. The billing process involves accurately documenting diagnoses, treatments, and procedures to ensure proper reimbursement from insurance companies and other payers. Overall, internal medicine billing is a critical part of the revenue cycle for medical practices and requires careful attention to detail and adherence to industry standards and regulations. While the procedures performed in internal medicine are generally straightforward, numerous minor procedures, prescriptions, and diagnoses require different codes.
Most Common Internal Medicine Billing Errors
Internal medicine billing errors can result in claim denials, delayed payments, and even audits, leading to a loss of revenue for the practice. Addressing and avoiding these errors can help streamline the billing process, increase revenue, and ensure compliance with regulations. Here are some common internal medicine billing errors to avoid:
Failure to Verify Insurance
In internal medicine billing, failure to verify insurance is a common error that leads to claim denials. Staff may assume that frequent patients’ insurance coverage hasn’t changed, resulting in an overreliance on routine. A verification step must be implemented for every patient visit to check for eligibility, authorization, coverage, and maximum benefits. By verifying insurance at every visit in your billing workflow, you can prevent policy-related issues that lead to denied claims.
Miscoding and Typing Errors
In internal medicine billing, miscoding and typing errors can lead to claim denials. Accidental mistakes such as unbundled codes, duplicate charges, inaccurate patient names, and incorrect dates can disrupt an insurance claim. To prevent this error, avoid submitting wrong information for insurance, or patient, entering incorrect ICD-10-CM codes, not entering codes at all, or submitting incorrect CPT codes in a given claim.
Utilize Modifier Appropriately
Using modifiers randomly is a common internal medicine billing error that can result in compliance and revenue issues. Modifiers are special two-digit codes added to services to inform the payer about any special circumstances surrounding the procedure. Random use of HCPCS and CPT modifiers can lead to incorrect information, misunderstandings, and a desire to get claims paid off. It is crucial to use modifiers correctly to ensure compliance and optimize revenue.
Stay Updated
Not staying up-to-date with current coding rules and practices is a crucial internal medicine billing error that can lead to costly coding mistakes. Keeping coders up-to-date is a wise investment for your practice, as outdated knowledge can result in compliance risks and lost revenue. Internal medicine practices must prioritize ongoing education and training for their coders to ensure the latest coding initiatives and rules. By staying up-to-date, your practice can avoid costly coding errors that impact your revenue and compliance.
Incomplete Claim Information
Incomplete claim information is a common internal medicine billing error that can result in claim denials. Even a single empty or unchecked box can cause a denial, making it crucial to ensure that all required fields are completed. To prevent this error, have a second set of eyes review each paper or electronic claim to provide all necessary fields are completed. If working with e-claims, check that your software system flags users to review missing fields before submitting the claim. By taking these steps, you can avoid costly claim denials and ensure a steady revenue stream for your internal medicine practice.
Front Office Challenges
In an internal medicine practice, the front-office staff faces several challenges due to the large volume of patients. One of the most significant challenges is scheduling appointments. The staff must handle many appointments, including routine check-ups, follow-ups, and urgent care appointments. Additionally, patients may need to reschedule or cancel appointments, which adds more work for the staff. Furthermore, annual scheduling for preventive care and routine visits can be challenging. The front-office team must ensure that each patient receives appropriate care according to their medical history, age, and other factors. This requires much time and coordination to ensure that all patients receive the necessary care and appointments.
Government Offerings And Incentives
Internal medicine practitioners often have a high volume of patients to manage as the first point of contact for many patients. This means they may be eligible for government offerings and incentives, such as those related to the meaningful use of electronic health records or participation in value-based care programs. Staying up-to-date on these offerings and incentives can help the internal medicine office maximize its revenue and provide the best possible care to its patients. Additionally, staying informed about coding trends and changes in the healthcare industry is essential to ensuring efficient billing practices.
Mismatching
The mismatch is a common internal medicine billing error where the billed items on a patient’s medical bill do not match their diagnosis. This type of error can cause confusion and frustration for the patient. The best way to prevent this error is to ensure that your internal medicine practice has a thorough coding process. This includes proper training of your staff on the accurate coding rules and providing them with an updated list of CPT codes to refer to when needed.
Related Codes On Claims
Related codes on different claims are an internal medicine billing error, whereas codes for related procedures are billed on separate claims. This can cause a denial of payment as it may appear to the insurance company that the services were duplicated or not medically necessary. It is important to ensure that related codes are billed together on the same claim to reflect the medical necessity and avoid confusion accurately.
The Bottom Line
It is crucial to prevent common coding errors to improve revenue for your internal medicine practice. Staying informed about new changes is key to avoiding mistakes, and outsourcing your billing and coding needs may be a helpful solution. While mistakes can happen, minimizing billing errors in your revenue cycle process is important. Outsourcing to a third-party medical billing provider can reduce the risk of errors and boost your revenue stream. I-Med Claims follows a streamlined approach that increases cash flow, reduces costs, and enhances clean claim rates. We have highly skilled medical billers proficiently handling denied claims using effective communication strategies. Our services also include conducting thorough research and evaluating insurers’ and payers’ accounts.
Focus on patient care and leave billing to the experts.
