Billing Mistakes That Are Costing You Thousands of Dollars

Medical billing is more than just submitting codes and collecting payments, it’s the financial backbone of your practice. One small error can delay reimbursements, trigger audits, and even result in revenue leakage. At MBNC, we help practices take control of their revenue cycle by identifying and eliminating the most common billing errors. Here are the ten most costly billing mistakes that cost your practice thousands of dollars.

1. Incorrect Patient Information

Even minor errors in patient details, such as misspelled names, incorrect insurance ID numbers, or outdated contact information, can cause claims to be rejected outright. These seemingly harmless mistakes often lead to payment delays and lost revenue when not corrected quickly.

2. Coding Errors & Mismatched Diagnosis Codes

Outdated CPT, ICD-10, or HCPCS codes, or mismatches between diagnosis and procedure codes, are among the top reasons for claim denials. Coding errors also increase the risk of compliance issues and payer audits.

3. Upcoding & Downcoding

Upcoding (billing for more intensive services than provided) and downcoding (billing for fewer services than rendered) are both red flags. Coding up may trigger audits and penalties, while downcoding results in underpayment and lost revenue.

4. Missing or Incorrect Modifiers

Modifiers provide important context for the services rendered, such as whether multiple procedures were performed in the same session. Using incorrect modifiers, or forgetting to include them, can lead to underpayments or outright denials.

5. Failure to Verify Insurance Eligibility

One of the most frequent, and most easily avoidable, billing mistakes is failing to confirm a patient’s insurance eligibility prior to treatment. Changes in coverage, inactive policies, or plan-specific restrictions can result in denied claims and unpaid balances.

6. Duplicate Billing

Duplicate billing (submitting the same claim more than once) is one of the quickest ways to draw attention from insurance payers and risk fraud investigations. It also results in denials and administrative rework.

7. Not Staying Updated on Payer Rules

Each insurance payer has its own set of billing guidelines, authorization requirements, and documentation standards. Failing to stay up to date on these ever changing rules leads to denied claims and administrative headaches.

8. Failure to Appeal Denied Claims

Many practices make the mistake of writing off denied claims without investigation. This results in thousands of dollars in lost revenue every year. Often, a simple correction or additional documentation is all that’s needed to turn a denial into a payment.

9. Lack of Proper Documentation

Insufficient or vague documentation can be just as harmful as incorrect coding. If a payer can’t clearly see medical necessity or services performed, they will reject the claim or request a refund later, sometimes with penalties.

10. Ignoring Compliance & Regulatory Guidelines

Failure to comply with regulations like HIPAA, Medicare billing rules, and state-specific laws can lead to audits, penalties, and even legal consequences. Non-compliance not only affects revenue but can damage your practice’s reputation.

Choosing MBNC To Minimize Your Billing Mistakes

Medical billing mistakes can quietly drain your practice’s revenue and place your compliance at risk. At MBNC, we specialize in medical billing and coding solutions that eliminate these costly errors and help you maximize reimbursements with: