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Avoid These Top 5 Family Practice Billing Errors

Family medical practices offer a comprehensive range of services across multiple fields of medicine. Medical billers working in family practices should thoroughly understand the diagnosis and procedure codes commonly used by physicians for accurate billing services. Accurately billing in family practices leads to higher reimbursements for the services provided. However, there are common mistakes made in family practice billing that can minimize revenue.

Most Common Family Practice Billing Errors 

The healthcare industry involves many components that must work together for patient treatment, insurance billing, and proper documentation. Healthcare providers use medical codes to inform insurance companies of the type of care provided. However, mistakes can occur, and each of these errors affects the billing process differently. It is crucial to be aware of them. Avoiding these five basic errors in family practice billing to maximize revenue is important.

Incorrect Coding

Incorrect coding is a common mistake made by physicians in family practice billing. If the codes are incorrect or poorly written, it can lead to claim rejections and the need for re-filing. Outdated code books can exacerbate this issue. Using the wrong code to obtain a higher reimbursement also opens the door to fraud. Coders must have a strong understanding of standard primary care coding for successful family practice billing.

Family practice often encounters various challenges, making it crucial to have an up-to-date CPT manual. This keeps coders and providers informed of revised, deleted, or newly added codes.

Inaccuracy In Documentation 

Entering inaccurate information for providers, patients, and insurance companies is a significant mistake in family practice billing. Filling out forms for family practice billing can be prone to errors due to the busy nature of physicians’ schedules. Even minor inaccuracies, such as incorrect patient spelling, can result in denied claims and the need for re-filing. It is recommended to follow a simple checklist and have another person review the form to ensure accuracy to minimize inaccuracies. This important information must be noticed, leading to problems in the future.

Ignoring Patient’s Insurance Coverage

Family physicians may need to pay more attention to the insurance coverage of their familiar patients, leading to claim rejections. They may assume that the patient’s insurance plan has not changed since their first visit. However, insurance coverage may have been terminated, or the patient may no longer be eligible for certain services due to changes in their insurance plan. It is important to verify insurance coverage, even for familiar patients, to avoid claim denials. Neglecting this step can result in denied claims and create difficulties later on, significantly if the patient’s insurance has changed or they are no longer eligible for certain services. It is crucial always to verify insurance coverage to avoid potential problems and ensure successful claims processing.

Negligent Chart Audit

The purpose of a chart audit is to monitor all aspects of a claim to ensure proper billing. Unfortunately, it is common for errors to arise if a planned test or procedure fails to occur, but the billing still proceeds. This could result in fraudulent billing practices, even if the mistake was not intentional. It is particularly concerning if services are billed separately instead of collectively, which increases the risk of such errors. It is essential to adopt proper procedures to keep track of all aspects of a claim to mitigate the risks of chart audits. One solution is to implement a system that alerts the billing team if a scheduled test or procedure does not occur but billing is still initiated. This helps to reduce the chances of fraudulent billing practices and promotes transparency in the billing process.

Under billing 

In a physician’s office, medical billers may need to become more familiar with the billing rules for services provided by Non-Physician Practitioners (NPPs). Physicians must have knowledge of incident-to-billing rules and shared visit regulations when hiring NPPs. If the services are not properly billed to Medicare, the physician may lose up to 85% of their scheduled fee, causing a significant loss of revenue. Additionally, physicians should educate themselves on the incident-to-billing rules and shared visit regulations to avoid losing a substantial portion of their scheduled fee. Keeping up-to-date with changes in regulations and having a well-informed billing team can help prevent under billing.

How To Prevent Family Practice Billing Errors

Ensure all staff members are trained and understand coding and billing rules well. Investing in reliable claims management software is crucial as it provides up-to-date, clean claims data. Here are the ways to prevent family practice billing errors that are essential for a smooth revenue cycle, reducing risk, and increasing collections. 

  • One of the ways to do this is to verify patient information. Double-check all details such as name, address, birth date, gender, insurance information, and date of treatment to ensure the accuracy of patient information and reduce the chance of claim rejection. Careful attention to these details by the billing department is essential to provide accurate information
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  • Medical billers and coders must be accurate to avoid errors in ICD coding. Thousands of different ICD codes are available, with more being added regularly. This is because even a minor mistake in coding can lead to rejected or denied claims. A helpful way to minimize rejections is to code with the highest specificity possible for a given code. Additionally, a comprehensive billing software system can help ensure that all codes are accurate and up-to-date.
  • It’s important to note the submission deadline set by each payer you work with, as it can lead to denied or rejected claims. Usually, insurance companies allow 60-90 days for the initial submission of claims and an additional 45 days for appeals. By creating a clear procedure and utilizing the tools available, such as claims management software, you can prevent missed deadlines and maintain the financial stability of your practice.
  • Always stay up to date with the latest changes in insurance policies, procedures, and guidelines, and make necessary updates to your billing process. This can be achieved by regularly reviewing your insurance contracts, attending training and educational seminars, and seeking guidance from experts in the field. By being proactive in verifying insurance information, you can minimize the risk of denied claims. It can ensure that your medical practice receives the full reimbursement it deserves.
  • Hiring a professional medical billing company can significantly benefit a medical practice. These experienced professionals are equipped to handle the challenges of managing rejected claims to dispute them. They have the necessary expertise to keep track of the numerous medical codes, diagnoses, and procedures to reduce the likelihood of billing errors. Outsourcing family practice billing and RCM to professional medical practices can save time and effort while ensuring accuracy in their billing process. This way, they can focus on providing quality patient care without worrying about the stress of billing and coding.

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