Five Medical Claim Errors and Methods to Avoid Them

by | Last updated Mar 28, 2023 | Published on Aug 5, 2019 | Data Entry Services

Digitization has become absolutely essential for almost all sectors. The healthcare industry is not an exception to this. However, converting large volumes of medical data into electronic format is really time-consuming and tedious. Reliable data entry companies offer medical data entry services that can considerably lighten this workload. These medical data entry services include insurance claims data entry, medical billing data entry and medical records data entry. These services are beneficial for physicians, hospitals, pharmacies, and insurance payers among others. If there are errors in medical data entry, these will lead to medical claim errors and consequent rejection or denial by the insurance company. It is worthwhile to understand how medical claim errors can be avoided.

Medical Claim Errors and Methods to Avoid Them

  • Patient’s Insurance Eligibility – Medical claims often get denied when a patient’s insurance policy does not cover the service you provide. This occurs when there has been a policy update to the patient’s insurance plan or when coverage for a particular service has expired.To avoid such a situation, it is necessary to verify insurance eligibility before treating a patient. Stan Loskutov, the Chief Information Officer at Medical Billing Group LLC says, before providing healthcare services to the patient, it is worth asking them to contact their insurer to check for any recent policy changes. He suggests that a two-physician practice should spend 1-2 hours per day performing eligibility verification. Patient coverage can be verified through an insurer’s website, by calling the company’s hotline with the support of a medical billing company, or by using medical billing software.
  • Double or Duplicate Billing – Duplicate billing is caused mainly due to human error. It occurs when a provider attempts to bill Medicare / Medicaid (health insurance programs) and either a private insurance company or the patient for the same treatment, or when two providers attempt to get paid for services rendered to the same patient for the same procedure on the same date. It may also occur when a provider attempts to charge more than once for the same service or happens when the provider is unaware of the process, or has not checked if the procedure has already been billed. A possible solution to this issue is that if a payment has already been made for a service, then there is no need to follow up with the insurance company. You need to focus on finding out why there was a mix-up among your billing staff. You should review your files before submitting claims. Usually, insurers process the original claims and block the upcoming claims. If your original claim has been processed, then focus on identifying and filling gaps within your billing staff to avoid future mistakes.
  • Coding Errors – Your claims may get denied if you enter an incorrect or inadequate ICD-10 code for one or more services.

Medical coding errors are of three types:

  • Upcoding – Assigning billing codes for a more expensive medical procedure or treatment than the one you actually performed.
  • Undercoding – This coding error occurs when the medical billing code does not adequately reflect the full extent of the services performed by the physician.
  • Insufficient specificity – This occurs when your code is not specific enough.

Physicians should document patient encounters as comprehensively as possible and keep detailed patient records with all information including laterality, severity and accompanying conditions to inform the codes you use.

  • Insurance Payer Mistakes – Your claims can also get rejected when the payer processes your claim incorrectly. In such a situation, call the insurance company to figure out why the claim was denied and ask them for reconsideration, if you think it was processed incorrectly. You can even write a formal appeal.
  • Data Entry Errors – You claims may get rejected due to data entry mistakes. It occurs when there is incorrect information in your claim, and you didn’t notice it until it was already submitted. So, before submitting a claim, you need to double-check whether the entered information is accurate. This will help avoid data entry errors to a great extent.

The following are some of the information that needs to be double checked:

  • The physician’s name, address and phone number
  • The patient’s name, sex, birthday and insurance information
  • The insurance company’s address and policy number

If your claim has been rejected due to a data entry mistake, you can call the insurer and ask for reconsideration.

Accurate data entry and processing in compliance with various regulatory standards is essential when it comes to claiming insurance payments. Outsourcing insurance claims data entry tasks to an experienced data entry company helps you get high-quality results with a very high level of accuracy.

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