10 Common Year-End Billing Errors and How to Avoid Them
by admin |December 30, 2024 | 5 comments,
As the year comes to close, it is time for medical practices to wrap-up patient care, finances, and ensure even better billing for the upcoming year. Year end brings with it the unique billing errors that delay claims processing, affect reimbursements, and create unnecessary headaches for both providers as well as the patients.
It is important to address medical billing and coding issues for improved claims processing. This lowers denial risk, and helps better overall financial performance. Below are the common billing and coding errors practices face during the year-end:
Overlooked Insurance Policy Changes
As the year ends, policy may change, including insurance plan renewals, new deductibles, and coverage adjustments. This is also the time when patients may consider changing their existing plan, switch between providers, or experience other updates that affect their coverage.
Incorrect Or Incomplete Patient Information
Incomplete and inaccurate patient details like name, date of birth, and addresses result in billing rejections. This mistake usually occurs when forms are being filled in a hurry, especially during busy year-end periods.
Misuse of Medical Codes- CPT, ICD-10, HCPCS
A very common mistake in medical billing is using incorrect or outdated codes. Be it the misapplication of ICD-10 or improper use of CPT, overseeing these leads to claim denials and delays.
Failure to Update Fee Schedules
Many healthcare providers fail to update their fee schedules in time for the new year. This results in inaccurate billing that might lead to overcharging the patients and underbilling the insurance companies.
Not Accounting for Deductible and Co-payment Changes
Insurance plans often adjust deductibles, co-pays and coinsurance rates at the end of the year. Not staying on top of these changes lead to incorrect billing, and patients may receive surprise bills they did not expect.
Ignoring the Year-End Expiration of Benefits
Some insurance benefits are tied to the calendar year. If patients haven’t used their full benefit by the end of the year, they might face difficulty if the provider fails to submit a claim before the deadline.
Missing or Incorrect Diagnosis Codes
Failure to match the diagnosis with the correct codes can result in rejection or delayed claims. If diagnosis isn’t clear, the coding may be incorrect, causing complications in claims approval.
Not Submitting Secondary Claims
After a primary insurance payer has processed the claim, secondary insurance may still have balances that need to be covered. Failing to submit secondary claims leads to unpaid balances, negatively affecting cash flow.
Inconsistent Claim Timelines
Submitting claims late or post deadlines causes delays in payment and even denial of claims. Many insurance providers require timely submissions with specific time windows. This is typically within the 30 days of the service date.
Failing to Reconcile Patient Balances
Patients’ balances are easily overlooked, especially during busy times of the year. Unpaid co-pays, deductibles, or outstanding balances cause confusion and delay in receiving payments.
How to Tackle These Common Issues and Avoid Them in The Long Run?
The challenges mentioned above are not easy to handle. Medical billing and coding expertise is needed to avoid these altogether. A medical and billing specialist like Instapay Healthcare Services has the necessary skills and knowledge that helps navigate these complexities. Our experience streamlines the billing process, minimizes errors, and improves reimbursement rates, ultimately improving healthcare operations efficiency. Here is how Instapay Healthcare Services’ solutions help your practice avoid any confusions:
- Instapay Healthcare Services verifies insurance coverage before a patient visits the provider. This confirms their policy details, benefits, and eligibility. Having an updated list of patient information helps you avoid billing errors concerning outdated or inaccurate coverage
- We make sure patient demographic information is complete, and correct. This helps avoid any problems. We ask patients to re-check their details during registration and review any update before their new appointment.
- By staying updated with the latest coding changes, our team of coders avoid coding misuse. Our robust system reviews codes before submissions, and uses coding software that keeps a check on accuracy to avoid these misuses. Our coding team is well-trained to help you in your practice.
- Reviewing and updating the fee schedule annually is a way to avoid setbacks. We make sure all the charges are accurate in reflecting current rates. Also, any changes in the pricing is reflected in the billing system and communicated with to the billing team to avoid any confusions.
- By verifying patient benefits at each visit, we keep a check for any deductibles or co-payments change. This helps accurately calculate patient responsibility at the time of service.
- Submitting claims in a timely manner before the year ends helps keep the year-end Expiration of Benefits issue at bay. This ensures that patients utilize their benefits and avoid issues with claims being processed in the new year.
- We review your diagnosis codes carefully and ensure they match the services rendered. Regular training and updates on ICD-10 codes helps improve accuracy.
- We make sure all claims are submitted to both primary and secondary insurance companies. By verifying secondary coverage information is collected at the time of the patient’s first visit, it allows in maintaining an organized system for diligent follow-ups.
- Establishing a streamlined process for submitting claims promptly. This creates internal deadlines that ensure that claims are submitted on time, and prioritize claims from the end of the year.
- Reviewing all patient accounts regularly and reconciling balances before the year ends. Sending out reminders for any outstanding payments and checking for any inconsistencies between what was billed and what was paid.
By being proactive about these common year-end billing errors, Instapay Healthcare Services improves efficiency of your medical billing and coding process. Accurate information, timely submissions, and regular reviews are key to avoiding unnecessary delays and rejections. We implement these strategies that help your practice maintain a smooth and successful transition into the new year, with fewer billing issues and more satisfied patients.
As the year ends, practices face billing and coding challenges that cause delays, denials and lower the chances of improved reimbursement. Common issues that can cause year-end billing problems include overlooking insurance policy changes, filling incorrect patient information, using obsolete medical codes, and missing expiration of benefits. To lower these errors, practices need to be diligent in their checks and reviews, and be updated with medical coding systems. Having to manage all these alongside practice and patient care can be taxing. This is when having medical billing and coding specialists who are well-versed in the process, and have full knowledge of the systems come to the help. Instapay Healthcare Services is a one-stop solution for entire billing and coding requirements. You streamline your practice when choosing to partner with Instapay Healthcare Services. Reduced errors result in improved reimbursements. This allows for a smoother transition into the new year.