Medical billing plays a big role in healthcare, but small mistakes can cause serious problems. These errors might delay payments, get insurance claims denied, or charge patients incorrectly. That’s why it’s so important for healthcare providers and billing staff to know the most common billing mistakes and how to prevent them.
Incorrect Patient Information
One of the simplest and most common mistakes is entering wrong patient details. This could be a misspelled name, wrong birthdate, or an incorrect insurance ID. Even small errors can cause claim denials, delays, and extra work. To avoid this, always double-check patient info before submitting a claim. Make sure it matches the insurance company’s records exactly.
Duplicate Billing
Duplicate billing happens when the same service gets billed more than once. This usually occurs when different staff members input data or when the system doesn’t catch that something has already been billed. Even if it’s unintentional, it can look like fraud and result in claim denials. To avoid it, use software that tracks billed services and make sure staff double-check everything before sending it out.
Unbundling of Services
Some procedures are supposed to be billed together in a package, but sometimes they get billed separately. This is called “unbundling.” It can increase costs and raise red flags with insurance companies, often resulting in denied claims. To prevent this, billing teams must know which services go together and always follow official coding rules.
Incorrect Coding
Billing relies on codes to describe each diagnosis, treatment, or procedure. If the wrong code is use, due to a typo, outdated info, or lack of knowledge then the claim can be denied, underpaid, or flagged for an audit. Coders should stay up to date on the latest rules and receive regular training to avoid these mistakes.
Missing Documentation
Every claim needs solid documentation to support it, like doctor’s notes explaining what was done and why. If that information is missing or unclear, the claim can be denied. Providers should ensure documentation is complete, detailed, and submitted with the billing.
Upcoding and Undercoding
Upcoding means billing for a more complex or expensive service than what was actually done. Undercoding is the opposite i.e., billing for less than what was done, often to avoid attention. Both are risky. Upcoding can lead to legal trouble, while undercoding reduces revenue. The best solution is to bill accurately.
Failure to Verify Insurance
Before treating a patient, it’s important to make sure their insurance is active and covers the service. Skipping this step can cause major billing problems. If coverage has expired or doesn’t include the service, the claim will be denied, and the patient or provider could get stuck with the bill. Always verify insurance before appointments, especially with new or recently changed plans.
Incomplete Claim Information
Claims must be fully completed to be accepted. Missing details like service dates, codes, or patient info can lead to rejections or delays. To prevent this, use a checklist or review process before submitting claims to make sure everything is filled out correctly.
Timely Filing Issues
Insurance companies have deadlines for submitting claims, called “timely filing limits.” If a claim is late, even if everything else is right, it might be rejected with no way to fix it. These deadlines vary, from 30 days to a year. Busy or understaffed offices can miss them easily. Use billing tools to track deadlines and submit on time.
Lack of Staff Training
Billing and coding are complex and always changing. If staff aren’t properly trained, they may use old codes, misunderstand rules, or miss steps, which leads to errors and lost revenue. Investing in regular training and certification keeps your team sharp and your billing accurate.
Why Partnering with MBNC Makes All the Difference
Avoiding these mistakes takes time, knowledge, and constant attention to detail. Doing billing in-house can take away time from patient care. That’s where MBNC comes in.
We specialize in fast, accurate, and dependable billing and coding. Our experienced team knows how to spot and fix errors before they cost your practice money. We stay current on coding updates, compliance rules, and insurance requirements, so you don’t have to.
By outsourcing to MBNC, you’ll see fewer claim denials, get paid faster, and improve your revenue, while freeing up your team to focus on caring for patients. Let us handle the billing, so you can do what you do best.
