Medical Billing - Solving the Problems Part I - Coding Errors

Medical billing in the United States is fraught withPotential Solutions
many challenges and problems. The primary goalSome electronic medical billing systems will now
of medical billing is to receive fair compensationemploy sophisticated Rules Engines that will check
for the work that was performed in a timelyyour claim before it is sent. Examples of some of
manner. However, this is rarely the case. Thisthe messages that you could see are:
series will explain those challenges and suggest- Diagnosis Code Requires Onset Date
possible solutions to these problems.- CPT: G0001 is invalid for the specified insurance
Coding Errorscompany
A large percentage of denied claims are due to- Procedure Requires Referring Physician UPIN
simple coding errors. Insurance companies processThese types of checks and hundreds more, can
claims through huge computer systems designedensure that the most common errors will be
to make sure every piece of information iscaught before a claim is sent to the insurance
correct. It is in the insurance company's bestcompany for payment. Reducing the amount of
interest to deny a claim and force a resubmissiondenials helps your practice in two ways. First, cash
for payment. This helps their cash flow andflow is increased due to faster payments. Second,
significantly impacts yours.the time required to look at a denied claim,
One study estimates that 90 percent of all claimresearch the problem, correct it, and resubmit it
denials are preventable. Healthcare Informaticscan be 5 times as long as the original submission
website states that, "Of 15 billion U.S. healthcaretime.
claims, 25 percent to 40 percent are rejected orTo ensure a smooth running billing operation by
denied at some stages in the administrativereducing the number of coding errors, insist on a
process. Only half of those are followed up andclaim scrubbing rules engine in your practice
resubmitted." Newer medical billing systems canmanagement system. Bottom line, clean claims
drastically help solve this type of problem.get paid faster.