Medical claims often get rejected owing to billing and coding errors. However, most of these errors are rather dumb in nature. This kind of errors can be avoided if the medical insurance specialist proofreads the entire claim form before filing it. Some of the most common silly mistakes committed during medical billing and coding are described below.
These are errors that occur when the insurance specialist is in a hurry. This mainly includes spelling errors that can be easily corrected if the claim form is proofread.
Omitting certain details or information can lead to rejection of the claim. It is the responsibility of the insurance specialist to check whether the claim contains all the necessary details like diagnosis codes, procedure codes, dates of service, tax ID number, identification number and the complete names of the patient as well as the policyholder.
Details On Support Documents:
Sometimes the documents submitted with the claim do not contain proper details about the policyholder. It is mandatory that these documents should contain the policy number and the full name of the policyholder.
Proper Claim Form:
The claim form should have all the details placed in the right spots. At times the forms are wrongly positioned in the printer and this result in misalignment of details entered in the form. Sometimes the bar code is not entirely visible owing to wrong stapling methods. Such mistakes can encourage the insurer to reject the claim.
Red Flags are factors that prompt an insurance provider to suspect a healthcare provider. Certain mistakes in the claims may arouse suspicion in the minds of the insurer who might initiate an investigation against the healthcare provider. Some of the common errors that can trigger such actions are mentioned below.
Any procedure mentioned in a claim should be supported by relevant documents that prove the occurrence of such a procedure. In the absence of sufficient documentation, the insurer finds it hard to believe that the procedure was actually conducted. In such cases, the insurer may reject the claim and initiate an investigation.
Each and every item entered in the claim should match with the procedure conducted on the patient. In case an item appears twice in a claim, the insurance specialist should offer sufficient supporting documentation that explains the matter. In the absence of proper explanation, this event is considered as a double billing.
Every procedure mentioned in an insurance claim should justify the condition of the patient. The treatment offered should justify the diagnosis. If any other kind of unusual procedure is mentioned, then it should be supported by a special rationale that explains the need of such an unusual procedure. In the absence of such a rationale, the procedure would be considered as a deliberate attempt to get more reimbursement from the insurer.
In a medical procedure several items are used. However, all the money spent on such items should be added with the cost of the procedure and mentioned as a single figure. If the insurance specialist mentions the cost of each item separately, then this might amount to a form of “double billing.”