8 Common Mistakes in Healthcare Billing

Despite these considerable stakes, it is estimated that the industry is rife with errors and mistakes:

• Up to 80% of medical bills contain billing errors, as estimated by Medical Billing Advocates of America CEO and founder Pat Palmer.
• Most healthcare leaders report increasing denials in recent years. (MGMA)
• Fraudulent billing costs more than $100 billion annually (estimated) – and accounts for up to 10% of total health spending.

As someone with extensive, hands-on experience in the billing and enrollment world (for locum tenens providers and full-time), I've seen firsthand how these challenges can impact organizations, and how one small oversight can result in the headaches of extra time and extra cost. Here are some of the top mistakes commonly seen in the billing process.

1. Lack of Documentation

Although it may sound like a no-brainer, it’s best to start with the most fundamental error. Accurate documentation is critical not only for clinical purposes but also for billing for those services. Providers need to ensure that their notes are descriptive, comprehensive, and up-to-date, accurately reflecting the services they are billing for. Failure to document services rendered results in an inability to bill for those services, leading to substantial revenue loss.

2. Incorrect Use of Modifiers

Modifiers are essential in medical billing, particularly the Q6 modifier commonly used for locum tenens assignments. Incorrect usage of modifiers can result in denials or even audits for your organization that may result in severe penalties

Many clients mistakenly apply the Q6 modifier incorrectly, not realizing that it only applies in locum tenens situations, where a Physician is temporarily replacing a Physician for under 60 days. The Q6 does not apply for any APPs.

You can read more about this on our guide to Billing for Locum Tenens.

3. Lack of Monitoring Billing Denials

Sending out a claim isn't the end of the process. In order to see claims through to reimbursement, it is key to continuously monitor for billing denials. Denials occur for various reasons, and without diligent follow-up, they can accumulate unobserved. It is estimated that up to 50% of denied claims are never resubmitted, leading to incalculable loss of revenue.

Our team provides comprehensive tracking and follow-up services during the enrollment process, ensuring that your organization can reduce denials or address them promptly.

4. Incorrect Procedure Codes

Accuracy in coding cannot be overstated. Submitting incorrect procedure codes, such as (for example) using a psychiatric CPT code for a neurological surgical procedure, can lead to claim denials and audits. It’s also worth keeping in mind the difference between traditional fee-for-service billing and billing with time-based codes.

Always double-check codes before submission to reduce the risk of errors and improve claim approval rates.

Sometimes services rendered are not billed due to the assumption that they cannot be billed for locum tenens. This is not true, and this misconception can account for significant revenue loss. Once all the individuals involved in the billing process have a clear understanding of what services can be , they are enabled to maximize revenue for the facility’s operations.

6. Duplicate Billing

It may be surprising that something as obvious as duplicate billing is in fact a common mistake. When a service is billed more than once, it can result in audits and penalties. As with incorrect procedure codes, a systematic approach and thorough review processes help prevent duplicate billing—and billing departments can benefit from a third party checking their work to catch these issues.

7. Upcoding

Upcoding involves billing for a more expensive service than what was rendered. Whether this is done out of ignorance or of a genuine attempt to bill for a higher reimbursement, it is considered fraudulent and can lead to severe consequences if discovered during an audit. Training and education, internal reviews, and compliance programs can help catch upcoding before it is too late.

8. Missed Filing Deadlines

Timely filing is crucial. For Medicare, claims must typically be submitted within 12 months from the date of service provided. When it’s over, it’s over—missing these deadlines means losing the opportunity to be reimbursed.

Don’t Go It Alone

In the often overwhelming business of healthcare billing and provider enrollment, mistakes can be costly. However, a detail-oriented approach during the enrollment process can help reduce errors and denials throughout the billing process.

Our team of billing and enrollment experts is ready to assist you with consultation on the how and why. Contact us on our Billing and Enrollment page to get started.