In this episode, we unravel the complex—but crucial—world of medical billing and its massive impact on the financial health of healthcare practices. Using insights from the article “Preventing Common Medical Billing Errors,” they break down five of the most common billing mistakes—from coding errors and missing patient info to duplicate billing—and reveal the real-world consequences these issues can create, including lost revenue, legal risk, and patient dissatisfaction.
But it’s not all doom and denials. The hosts also share actionable best practices and tech solutions to catch errors before they cause damage—like scrubbing claims, verifying insurance at every visit, and tapping into powerful Revenue Cycle Management (RCM) services.
Whether you're running a small clinic or managing a busy team, this episode will help you turn billing chaos into clarity, and ensure your practice gets paid what it’s earned.
Don’t miss this episode—tune in now to learn how to spot and stop the most costly medical billing errors before they impact your practice.
Transcript
Narrator: 00:00
Welcome to the Billing Blueprint Podcast, your go to resource for innovative medical billing solutions. Each episode we explore the latest industry trends and share proven strategies to help your practice streamline operations and get paid faster. Now here are your hosts, Brad and Sarah.
Brad: 00:21
Welcome to the Deep Dive. Today we're getting into a world that often feels, well, kind of like a secret language, but it really dictates the financial heartbeat of almost every healthcare practice.
Sarah: 00:33
Medical billing.
Brad: 00:34
Exactly. It's incredibly complex, totally critical, and, you know, a place where tiny slip ups can just snowball into massive headaches. It hits everyone from the clinic owner right down to the patient. So we're going to try and navigate this landscape today, shine a light on the common pitfalls and maybe more importantly, talk about some powerful solutions.
Sarah: 00:54
Yeah, and our main source for this is a really insightful article called “Preventing Common Medical Billing Errors.” And it's good because it doesn't just list the problems, it actually walks through five specific really common errors and then lays out concrete strategies, you know, ways to prevent them, plus some info on tech solutions that can help.
Brad: 01:12
Right. So our mission today really is to give you a kind of shortcut, help you understand exactly where mistakes often happen in medical billing, why these errors ripple outwards so much and how, well, how diligence combined with the right systems can genuinely change a practice's financial health.
Sarah: 01:30
Trying to get to that aha moment.
Brad: 01:32
Yeah, exactly. Help connect the dots on this vital topic. So, let's start with just the reality of a healthcare practice. They are usually pretty hectic places, right?
Sarah: 01:41
High pressure, definitely.
Brad: 01:43
Which, you know, unfortunately makes them prone to mistakes, even tiny ones. Think about the constant flow of patients, all the detailed paperwork, getting the coding just right under pressure.
Sarah: 01:52
That's a lot to juggle.
Brad: 01:54
So what does all that chaos actually mean for the smooth running of a practice, financially speaking?
Sarah: 01:59
Well, it means that while accurate medical billing is like non-negotiable, the sheer act of juggling patient care with all the admin stuff creates fertile ground for errors. It really does. We're talking simple things sometimes like a drop digit in an insurance number or typing a code wrong, or even services that were done but just didn't get documented properly. And these aren't just small oopsies. These seemingly minor things can seriously disrupt the revenue cycle. They can frankly starve a practice of the money it's already earned.
Brad: 02:31
It's amazing, isn't it, how something so small can throw everything off. Yeah. And okay, no process is perfect. We get that.
Sarah: 02:38
Right.
Brad: 02:38
But just being aware of these common errors, both on the insurance side and the patient payment side. That feels like the first big step. It helps avoid preventable problems. It's about being proactive.
Sarah: 02:49
Precisely. And that proactive piece is key because catching things early minimizes those costly downstream effects. The source really emphasizes focusing on finding errors quickly, putting systematic checks in place, and building a culture, you know, within the practice that's really focused on accuracy. And here's a striking statistic they mentioned. About 10% of medical claims get rejected because of compliance issues.
Brad: 03:12
10%. Wow.
Sarah: 03:14
1 in 10 just rejected. Think about the lost revenue, the extra work that creates.
Brad: 03:19
That's. That's huge. It almost sounds like practices might be unintentionally shooting themselves in the foot by not catching these things.
Sarah: 03:27
It can feel that way.
Brad: 03:28
Okay, so where do these common errors actually creep in? Let's. Let's break down the five most frequent culprits the article points out.
Sarah: 03:35
Okay, sounds good. The first big one is coding errors.
Brad: 03:39
Right?
Sarah: 03:40
And this isn't just picking a wrong code. It's more intricate. It's about selecting the exact right healthcare billing code. Or sometimes multiple codes to perfectly capture the treatment, the diagnosis, the procedure, everything.
Brad: 03:53
So getting the details right.
Sarah: 03:55
Exactly. For example, coding a simple office visit as, say, a more complex specialty procedure. That'll get denied fast.
Brad: 04:02
Why does that happen, though?
Sarah: 04:03
Well, it could be outdated code books, maybe. Coding too quickly under pressure. Sometimes the cases are just complicated. Or honestly, just not enough training for the staff involved.
Brad: 04:13
And I imagine with new treatments and codes coming out all the time, just keeping up must be tough.
Sarah: 04:19
It really is.
Brad: 04:20
Okay, what's the next major error category?
Sarah: 04:23
Second is missing or incorrect patient information.
Brad: 04:27
Ah, basic details, yeah, but even small.
Sarah: 04:29
Gaps or typos in a patient's record can totally invalidate a claim. Things like duplicate names causing confusion, transposing numbers in a date of birth, getting the insurance policy number wrong. Frustratingly common stuff.
Brad: 04:43
Why does that happen? Simple mistakes, usually.
Sarah: 04:46
Yeah. Human error during data entry, maybe trying to read messy handwriting on forms. Or sometimes the patient themselves accidentally gives the wrong info. It's a breakdown right at the start.
Brad: 04:55
Just one wrong digit derails the whole thing. Okay, what about billing for things that insurance just doesn't cover?
Sarah: 05:01
That brings us to number three, non-covered services. Okay, this isn't always obvious stuff like cosmetic surgery. Sometimes it's more subtle, like changes in an insurance policy or specific details within that particular patient's plan that catch the practice out.
Brad: 05:17
So you need to know the specific plan, not just the insurer.
Sarah: 05:20
Absolutely. Like billing for a certain type of therapy. That this patient's specific insurance plan explicitly excludes. This happens mostly when there's no upfront check, no confirmation of the coverage terms before the service happens, leads to denied claims or wasted effort and unhappy patients.
Brad: 05:37
Right. That upfront check seems critical. Okay.
Sarah: 05:40
And the fourth error, number four, is unbundling.
Brad: 05:42
Unbundling?
Sarah: 05:43
Yeah, it's basically breaking down related services and billing them separately when there's actually a single comprehensive code that should cover them all.
Brad: 05:51
Can you give an example?
Sarah: 05:52
Sure. Like billing separately for the preoperative visit, the surgery itself, and the post operative care, when there's often an all inclusive or global code designed for that whole episode of care.
Brad: 06:04
Why would a practice do that?
Sarah: 06:05
Well, sometimes it might be pressure to maximize reimbursement, honestly. But other times it's genuinely not. Understanding the complex billing rules like those global periods or specific insurance company guidelines about what gets bundled together. It's a fine line.
Brad: 06:19
Yeah, sounds like a tricky area. And the last one? What's number five?
Sarah: 06:24
Finally, we have duplicate billing.
Brad: 06:27
Okay, that sounds straightforward.
Sarah: 06:29
It is what it sounds like. Accidentally sending the same claim in twice.
Brad: 06:33
How does that happen?
Sarah: 06:34
The source mentions things like maybe a computer glitch causing a double entry. Or sometimes when a claim gets rejected and needs to be fixed and resubmitted, the corrected one might accidentally go in alongside the original error.
Brad: 06:47
And the consequence?
Sarah: 06:48
Best case, it just delays payment while the insurance company sorts it out. Worst case, it can look like fraud, even if it was an honest mistake, which. Which triggers alarms and audits.
Brad: 06:58
Wow. Okay, so we've laid out the problems. It definitely sounds like a billing minefield.
Sarah: 07:02
It can be.
Brad: 07:03
But the good news is there are concrete things practices can do. This is where it gets really interesting. What are the absolute must do best practices to get ahead of these errors?
Sarah: 07:14
Yeah. This is crucial. It's all about being proactive, preventing the problems in the first place. One of the absolute biggest things is to verify eligibility and coverage.
Brad: 07:22
Okay.
Sarah: 07:22
And crucially, do it at every single patient visit. Don't assume the info from last time is still good.
Brad: 07:29
Right. Things change.
Sarah: 07:30
Exactly. Confirm their insurance is active. Make sure the procedure codes you plan to use are actually covered for that patient under that plan. Get preapprovals if they're needed, and update patient records immediately if anything changes.
Brad: 07:44
Makes sense.
Sarah: 07:45
What else? Next up, scrub claims before sending.
Brad: 07:49
Scrub them by cleaning them up.
Sarah: 07:51
Sort of. Yeah. Think of it like quality control. Before that claim goes out the door, run systematic checks. Look for duplicates, missing info, invalid codes, any inconsistencies.
Brad: 08:04
So catch errors internally first, Precisely Review.
Sarah: 08:07
Anything the system flags before it even gets to the insurer. It's like building a financial turn potential denials into definite payments.
Brad: 08:16
That's a smart way to think about it. What about after the claims are sent?
Sarah: 08:19
Then you need to actively check EOBs for denials. Those explanation of benefits forms, they're gold.
Brad: 08:24
Why is that?
Sarah: 08:25
Because they don't just say deny, they tell you why. That gives you the exact reason so you can fix the error, resubmit quickly. And importantly, spot patterns. Maybe the same mistake keeps happening.
Brad: 08:35
Ah, okay, so it's a feedback loop.
Sarah: 08:37
Exactly. And related to that is the need to stay current on coding. This is huge because the codes change constantly. Practices really need to subscribe to update services. Do regular staff training, make sure everyone is using the latest code definitions. And do routine internal audits just to check coding accuracy.
Brad: 08:57
Sounds like ongoing education is vital.
Sarah: 08:59
It really is.
Brad: 09:00
Beyond coding, what about making sure the bill matches what actually happened with the patient?
Sarah: 09:05
Right. That's where comparing claims to notes comes in. It's simple but effective. Just cross reference the charges on the claim with the clinical documentation in the patient's chart.
Brad: 09:13
And if they don't match?
Sarah: 09:15
That's a red flag. It signals you need to review the records, maybe educate staff, perhaps adjust a process. It connects the clinical side to the admin side.
Brad: 09:23
Makes sense. Anything else on the best practices front?
Sarah: 09:26
One more big one. Carry out self-audits periodically.
Brad: 09:29
Like internal reviews.
Sarah: 09:31
Exactly. Go beyond the daily checks. Regularly review coding accuracy, patient coverage details, compare services billed against payments actually received. Check if you're following policies, if your processes are sound, if the training is working. It's like a health checkup for your whole billing system.
Brad: 09:49
That's a really thorough list. It raises a big question for me though. How can technology help with all this? It feels like it could be a massive help.
Sarah: 09:57
Oh, absolutely. It's a game changer. Utilizing billing technology cuts down manual errors significantly through automation.
Brad: 10:04
How so?
Sarah: 10:05
Well, think about sending patient statements electronically instead of stuffing envelopes. Importing patient info directly from electronic medical records instead of retyping.
Brad: 10:14
It reduces typos. Right there.
Sarah: 10:15
Exactly. Verifying patient details against huge databases, instantly, automatically detecting if you're about to send a duplicate bill. It just streamlines so much of that error prone manual stuff. Frees up staff time too.
Brad: 10:27
That sounds incredibly useful. But let's be real. Errors might still happen sometimes. Right? Even with the best tech and processes.
Sarah: 10:34
Totally. Perfection is tough to achieve.
Brad: 10:37
So what happens then when a mistake does slip through?
Sarah: 10:40
When that happens, the focus has to be on Fixing mistakes quickly.
Brad: 10:44
Speed matters.
Sarah: 10:45
Absolutely. Jump on it. Issue patient refunds promptly if needed. Resubmit corrected claims without delay. Figure out the extent of the problem, disclose it appropriately, especially if a patient was overcharged. And then, crucially, adjust your processes so it doesn't happen again. Speed and transparency are vital.
Brad: 11:03
That proactive response, it sounds like it's also about the overall team culture, isn't it? Not just rules, but how people approach them.
Sarah: 11:09
You nailed it. It's essential to reinforce, diligence, build a genuine culture of accuracy.
Brad: 11:15
How do you do that?
Sarah: 11:15
Consistent, thorough training for new people. Documenting processes clearly so everyone's on the same page. Maybe even incentives for preventing errors. When the whole team understands why accuracy matters and feels empowered to maintain it, the practice's financial health just thrives. Compliance risks go way down.
Brad: 11:34
It's clear how much effort needs to go into prevention. So let's flip it. What happens if these errors aren't fixed quickly? Or if a practice just lets them pile up? What are the bigger, scarier ripple effects?
Sarah: 11:47
Yeah, the consequences go way beyond just claim denials and slow payments. First off, there's significant financial loss.
Brad: 11:53
Blocked revenue.
Sarah: 11:54
Yes, but also think about the staff time spent chasing down problems, fixing errors. That's a direct labor cost. Cost it constrained budgets so much that, believe it or not, some practices might need loans just to cover operations or delay important investments.
Brad: 12:09
Well, okay, what else?
Sarah: 12:10
Then things get really serious. Legal penalties. We're talking potentially hefty fines, and in really bad cases, even criminal charges. If billing practices look fraudulent, whether it was intentional or just extremely negligent, the legal system often doesn't care about intent. If the negligence is bad enough, that's.
Brad: 12:28
That's terrifying for a practice owner.
Sarah: 12:30
Yeah.
Brad: 12:30
What about the patients? How does it affect them?
Sarah: 12:32
Patient dissatisfaction is huge. Getting incorrect bills, that destroys trust fast. I can imagine it leads to complaints to insurers. And patients are definitely willing to switch providers over billing issues. Especially if they get hit with unexpected out of pocket costs they weren't prepared for. It really damages that core relationship.
Brad: 12:51
And that probably leads to reputation issues, too.
Sarah: 12:54
Absolutely. That feeds right into reputation damage. Word gets around. Even if it's just persistent billing hassles rather than outright fraud. That word of mouth can badly hurt a practice's reputation, making it harder to attract new patients and damaging referral networks. Negative online reviews, things like that.
Brad: 13:13
Yeah, that makes sense in today's world. What about the insurance companies? Do they step in?
Sarah: 13:16
They do. Patterns of mistakes inevitably lead to insurance audits. If an insurer sees repeated errors, they'll likely launch a full review, which means.
Brad: 13:25
More work for the practice.
Sarah: 13:27
A ton more work. Providing masses of records, explaining every discrepancy, correcting things under scrutiny. It pulls staff away from actual patient care. It's a huge administrative burden.
Brad: 13:37
And are there other compliance issues?
Sarah: 13:39
Yes. Finally, there are potentially severe compliance violations. Beyond the fines, repeated problems increase the risk of regulators stepping in. This could mean short term suspensions of the practice, or maybe ongoing. Ongoing oversight requirements. Both are costly, time consuming and limit how the practice can operate. Just a massive headache, man.
Brad: 14:01
The stakes are incredibly high. It affects everything. Finances, reputation, patient trust, even the ability to operate. So let's bring it back to solutions. How can technology and specialized services really help tackle these problems head on?
Sarah: 14:15
Well, that's exactly what these solutions are designed for. To take away those billing and revenue cycle headaches. For instance, you might have a strong cloud-based application that automates the patient side of billing.
Brad: 14:25
Setting bills automatically.
Sarah: 14:26
Yeah, sending eBills, offering lots of payment options. Online, mobile paying in the office, automated payments, even financing options like FlexPay plus tools to help with patient collections. This stops a lot of patient balance errors before they even start.
Brad: 14:40
Okay, that handles the patient side. What about the insurance claims?
Sarah: 14:43
That's where things like revenue cycle management or RCM services come in. This basically lets practices outsource their insurance billing to a dedicated team of experts.
Brad: 14:54
So someone else handles the claims?
Sarah: 14:55
Right, a specialized team. They often manually review claims before they go out, catch errors, and then they handle any denials that come back. It takes a huge load off the practice staff.
Brad: 15:05
So combining automation and expert help.
Sarah: 15:07
Exactly. Between automated systems for patient billing and expert RCM services for insurance practices. Get that end-to-end support. It drives accuracy, prevents errors, keeps the money flowing.
Brad: 15:19
This deep dive has really hammered home how vital it is to get a grip on common billing errors. You know, the coding mistakes, bad patient info, non-covered services, that unbundling issue, even simple duplicates. And we've also seen the best practices that really work. Checking eligibility every time, scrubbing those claims, auditing yourself, ongoing training, it's a lot, but it matters.
Sarah: 15:42
It really does. And we saw the consequences if you don't do it. They're serious. It just reinforces that. Investing in the right systems, the right processes, and just maintain that vigilance, it's absolutely critical. It contains the damage, keeps you compliant and secures the financial health of the practice. At the end of the day, that's what it's about.
Brad: 16:00
So thinking about all this, how absolutely critical, accuracy. And these systematic checks are in something as complex as medical billing. It makes you wonder, right? How could identifying similar weak spots, similar vulnerabilities, and applying these kinds of proactive strategies help you prevent errors or improve processes in totally different, complex systems? Maybe in your own job, or even just in managing complex parts of your own life? Something to think about thanks for tuning.
Narrator: 16:27
Thanks for tuning into the Billing Blueprint podcast. For more insights or to dive deeper dive deeper into today's topics. Head over to billflash.com. Don't forget to subscribe and we'll catch you next week with more strategies to keep your practice running smoothly and getting paid faster
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