Top 10 In-House Medical Billing Mistakes and How CoeurPractice Fixes Them

1. Inaccurate coding: Common errors in this category are not billing the proper procedures, missed codes, omissions of a service performed by either the doctors or Nurses/MA’s, charging at a lower complexity level, incorrect use of or lack of modifiers.
   
   

   Cost Impact: It is estimated that 15% of procedure codes are recorded in error, mostly under-coded. This is estimated to result in 23-25% missed revenue.

   What we do: CPC performs random audits to match coding to chart notes, also review month-end reports to evaluate the evaluation and management codes and compare by specialties nationwide. Also educate on recording accurate chart notes.

2. Missed underpayments by the carrier – It is estimated that 30% of the claims submitted are underpaid or not paid per the terms of the contract with the carrier.
   
   

   Cost Impact: Lost revenue from these errors are estimated to be 8% of all collected revenue.

   What we do: CPC reviews carrier contracts and monitor payments to ensure that carriers are paying according to the contracts. CPC has the ability to challenge/correct electronically where most in-house billers are doing re-adjudication by paper and mail, resulting in getting paid on average 5-7 weeks sooner.

3. Ineffective systems to detect fraud and theft – Partially due to a suffering economy, it is estimated that over 40% of medical practices have experienced significant levels of fraud/theft,  including embezzlement, theft of over-the-counter money and petty cash, providing unauthorized discounts, waiving co-pays, accepting fraudulent credit cards. Problem is exacerbated by lack of proper financial controls, including segregation of duties, daily balancing, lack of receipt logs.
   
   

   Cost Impact: Total estimate for physician offices is in the thousands of dollars.

   What we do: Professional financial accountability/balancing systems are installed including segregation of duties; daily balancing of the books; physician confirmation of balance adjustments; fraud prevention policies and procedures regarding accepting cash and credit cards; ID theft protection programs available to guard against credit card fraud.

4. Inefficient processes for monitoring claim denials and turn-around time – Most physician practices do NOT confirm through the clearinghouse that the claim has been received or rejected for errors. Tracking the resubmission of claims is also rarely done.
   
   

   Cost Impact: At best, causes serious cash flow problems; at worst, if error is not identified, payment for the procedure will be missed.

   What we do: CPC has confirmation within 2 hours that claim is approved or denied and confirmation of claim in-process within 24 hours. Errors are identified within 2 hours and resubmitted same day.

5. Undertrained staff performing  billing and collections – Most medical practices are comprised of untrained, uncertified, inexperienced medical billing staff with no formal training, resulting in missed charges by procedure, missed codes, missed modifiers or diagnosis codes.
   
   

   Cost Impact: Missed revenue, delays in payment and, at worse, accusations of fraud against the  doctor.

   What we do: CPC has highly trained, certified coders on staff who have to be continually re-certified, trained to spot coding errors and held accountable by their certification board to follow all federal, state and local coding laws.

6. Outdated technology: Most doctors update their technology every 3-4 years missing out on the most recent advancements that enable them to get the most out of their billing.
   
   

   Cost Impact: Outdated technology results in inefficiencies and mistakes resulting in lost revenue.

   What we do: CPC invests thousands of dollars in technology advancements each year, giving its clients the best chance to collect the maximum revenue do to them in the most efficient manner.

7. Inaccurate patient information – Most offices are unable to keep current on patient personal information including addresses and insurance benefits. Most practices do not address mail returns in a timely fashion, do not have effective methods for capturing address changes, thus making the billing and collection process more difficult.
   
   

   Cost Impact: At best, collections are delayed, at worst, they result in lost revenue.

   What we do: CPC has reciprocal feedback systems with the Postal Service that provides immediate correction of wrong address, decreasing mail returns and collection delays.

8. Slow billing cycles – The common procedure of most practices is to send statements once per month after insurance payments have been received.
   
   

   Cost Impact: This causes interruption of cash flow and sends wrong message to patients about the importance of satisfying their medical debt.

   What we do: CPC sends patient statements immediately upon receipt of carrier payment, increasing physician cash flow.  Patients with no insurance are contacted within 48 hours when claim is received at CPC to arrange payment.

9. Outdated provider contracts – Billing departments are often not notified of changes to provider contracts with insurance carriers
   
   

   Cost Impact: Submitting claims based on outdated provider contracts result in denied claims and delayed or missed payments.

   What we do: CPC becomes involved in the re-contracting process with insurance carriers, enabling CPC to be immediately informed of fee schedule changes.

10. Incorrect recoupment of rejected claims by insurance carriers – Insurance carriers frequently take back funds for claims previously paid for various reasons including patient ineligibility, patients with other insurance, and classification as workers comp claim, many times incorrectly.
    
    

    Cost Impact: Most practices do not have feedback systems to challenge the validity of rejected payment by the carriers, resulting in significant lost revenue.

    What we do: CPC has systems to back-check all rejected claims to determine the accuracy of the non-payment. Non-payments are disputed if found to be unfounded.