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How Much $$$ Are You Leaving on the Table?

"All policy is a matter of gains and losses, upsides and downsides"
--Michael Mandelbaum

Losing anything is a huge pet peeve of mine. Over time, I've lost some essential things like keys, eyeglasses, and even my cell phone. But, of all the items we all lose, lost money is the worst!!! I don't mean in the sense of dropping a $20 bill in the grocery store or an unrecovered debit card. I'm talking about the loss in ongoing or expected revenue. We know unexpected things are possible in the back of our minds, but we don't always know how to prevent them. Often, the unexpected is brought on by errors or mistakes that are unforeseen. Even small mistakes or errors can cause a world of hurt for anyone. This is especially true in running, operating, or owning a business. For HCPs and their practices, minor and unintentional mistakes can carry hefty consequences. Billing and coding errors result in HPCs leaving billions of dollars on the table each year.


Reports show approximately 6-8% of lost revenue stem from billing or coding errors. Practices may be losing up to a quarter of their annual revenue due to these mistakes. When these things happen, organizations lose again because they have to pay back affected clients. Dedicating the needed attention to these errors before they occur could reduce these particular losses. A rate of 7-75% of medical claims contains errors. Not only are practices losing revenue, but these common mistakes could also lead to abuse or fraudulent claims against the companies. Billing errors also lead to an increased feeling of stress for patients. Upset or uneasy patients make it difficult for HCPs to give proper care when patients have issues with their bills. A thorough double-check of information before it's submitted could prove beneficial to practices. I've outlined the six most common billing and coding errors and how they affect organizations.



1) Not Enough Data

Failing to provide payers information to support claims results in denials or delays. Although employee errors cause some of these mistakes, they can also occur if physicians haven't given enough or inaccurate diagnosis information.



2) Upcoding

Upcoding is when patients are billed for more complicated procedures than they've received or when bills are submitted for services that a patient has never received. Upcoding can also happen when the billing department makes a mistake while entering diagnosis or treatment codes. If the employee doesn't understand the information provided by the physician and enters the wrong codes, this can also be considered upcoding.


3) Undercoding

Undercoding happens when a provider leaves a medical billing code for less expensive procedures. The HCP may be trying to avoid an audit or maybe trying to save money for a patient. Undercoding can also occur from a simple mistake but can look suspicious and result in severe penalties for your practice.


4) Missing or Incorrect information

Errors are a common cause of claim denials and can be easily prevented by giving a once-over of all fields where information was entered. This should always be done before submitting a claim. Incorrect or missing patient information can cause multiple unforeseen problems. Some information can be accidentally entered into a patient's record. These mistakes go through an investigation process, and the claim will be denied. When billing departments are busy, these mistakes can easily be overlooked or unnoticed.



5) Incorrect procedure Codes

Sometimes, information can be documented incorrectly on forms or supporting documents. Employees may not follow the latest coding rules when claims are returned to your practice too often from containing the wrong procedure codes. To prevent issues in your reimbursement, ongoing training should be available. This helps ensure your employees know the latest coding requirements and best practices. One of the best ways to improve efficiency is to use the proper medical devices. According to your business needs, you must choose the most appropriate instruments for your organization.


6) Unbundling

This occurs when healthcare providers use billing codes for two or more separate procedures, but the procedures were performed together. Government healthcare programs reimburse more money for services when they are performed separately. Therefore, unbundling is sometimes an intentional mistake made to receive more money.


With the fast pace commotion and high volume of needs to be met in HCPs organizations, the loss of revenue should be the least of your concerns. Having happy and satisfied patients should be your top priority. Outsourcing to experienced professionals ensures your billing and coding is correctly done for you. Accuracy and efficiency are vital to your organization, and focus more on your top priority, providing comfortable care. Please feel free to follow the links and look us up online to know how outsourcing could benefit your practice. Of course, we want you to want us, but most importantly, we want you to be successful in your practice and leave a minimal amount of revenue on the table.

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