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7 Common Medical Billing Problems and Their Solutions

Medical billing is a necessary task for every physical therapy practice. Even when it’s a priority, problems can occur that can slow down your cash flow and result in denied claims and financial difficulties. The key is to have a practice management software that minimizes the chances of billing problems. We often have clients ask us what solutions we recommend when problems occur. Here are 7 common medical billing problems and their solutions.

#1: Incorrect Patient Identifier Information

When you’re entering patient information into your billing system, even a minor distraction can cause errors. But every provider knows that insurance companies deny claims every day for minor errors like spelling a patient’s name wrong or reversing numbers on their date of birth.

There are two ways to handle this problem and prevent it from happening. The first is to double-check every entry you make to ensure that it’s correct. The second is to choose practice management software that auto-populates the patient bill based on their verified information. If you have patients enter their own information and confirm it with you before their first initial evaluation appointment, there’ll be virtually no chance of this kind of mistake delaying a payment.

#2: Missing Information

Another common mistake is leaving out necessary information on a claim, such as the patient’s date of birth or the date of an injury. A blank field can lead to a denial from the insurance company even if there’s no incorrect information and the patient has coverage.

The solution is to scan your claims before you submit them to make sure there is no information missing or blank fields. It’s your best opportunity to catch omissions before they lead to a time-consuming denial and resubmission process.

#3: Improper Coding

We’re confident saying that improper coding of medical claims is one of the most common and time-consuming mistakes made by physical therapy practices. There are several reasons that claims end up being coded improperly:

  • Use of outdated coding books
  • Unbundling of charges that should be handled under the same procedure code
  • Upbilling and underbilling
  • Mismatched codes
  • Missing codes
  • Billing CPT codes that are not in your insurance carrier's contract

While upbilling and underbilling may be fraudulent, they can also occur by accident. The solution is to choose a medical practice management solution that includes coding automation that’s updated to reflect the most recent coding requirements.  Using a software that has the capability to only list codes specific to each medical insurance carrier can easily reduce billing time and leave no room for errors to occur.  When your staff can look up diagnosis codes and procedure codes easily, the chances of them making a mistake is greatly reduced.

#4: Duplicate Billing

Sometimes one member of your staff will prepare a bill for a patient, and then another will do the same thing – not realizing that the bill has already been prepared.  In that case, there would be a double bill that could result in double charges to the patient and potentially an annoyed customer.

This is an issue we had to guard against before we created HENO. With manual billing and spreadsheet management, it’s easy to make mistakes of duplication.

The solution is automation, which can create a bill automatically and flag duplicates if someone attempts to create an additional bill for the same services and treatments.

#5: Missing Documentation

Every insurance provider requires documentation to pay claims. Without it, they may simply deny a claim and send it back to you, in which case you’ll need to provide the necessary documentation and resubmit the claim.

The solution is to ensure that your staff is properly trained to recognize when documentation is required to prove medical necessity. Ideally, your billing software should make it easy for you to attach documentation at the same time you submit a claim.

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#6: Service Not Covered

Patient insurance coverage can change for a variety of reasons, such as a change in employment. There may also be limitations on how many physical therapy visits or treatments are covered, and when a patient maxes out on their coverage they’ll need to pay out of pocket. Improperly billing an insurance company can lead to costly delays and make it more difficult to collect from the patient or their new carrier.

The solution is to verify the patient’s coverage at every visit. You’ll need to ask the patient to verify their insurance while checking to make sure that their benefits have not maxed out.

#7: Missing Referral or Authorization

Some medical plans require patients to get a referral from a primary care physician or an authorization from patient services before receiving physical therapy. If the referral or authorization is missing, the claim will be denied.

Here again, you’ll need to double-check with the patient and make sure that your staff is familiar with carrier limitations and requirements. If the referral is missing, you can work with the patient to get it before you submit the claim.

Proper medical billing requires attention to detail. Addressing the 7 common mistakes we’ve mentioned here will ensure that your bills are accurate and your patients are taken care of properly. Having an easy to use practice management software can help automate these processes and remove the stress of billing. To learn more about how HENO can streamline your practice management, click here to schedule a free demo.

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