7 Common Medical Billing Problems and Their Solutions

Medical billing is a necessary task for any physical therapy practice. Even when it is a priority, problems can arise that can slow cash flow and lead to denied claims and financial difficulties. The key is to have practice management software that minimizes the chances of billing problems. Clients often ask us what solutions we recommend when problems arise. Here are 7 common medical billing problems and their solutions.

#1: Incorrect patient identifier information.

When you're entering patient information into your billing system, even a small distraction can cause errors. But all providers know that insurance companies deny claims every day for minor errors like misspelling a patient's name or reversing the numbers on their date of birth.

There are two ways to handle this problem and prevent it from occurring. The first is to double-check every entry you make to make sure it is correct. The second is to choose practice management software that automatically populates the patient's bill based on their verified information. If you have patients enter their own information and confirm it with you before their first initial evaluation appointment, there will be virtually no chance of this type of error delaying a payment.

#2: Missing information

Another common mistake is omitting necessary information on a claim, such as the patient's date of birth or the date of an injury. A blank field can result in a denial by the insurance company, even if there is no incorrect information and the patient has coverage.

The solution is to scan claims before submitting them to make sure there is no missing information or blank fields. This is your best chance to catch omissions before they lead to a time-consuming denial and resubmission process.

#3: Incorrect coding

We're sure that incorrect coding of medical claims is one of the most common and time-consuming errors in physical therapy practices. There are several reasons why claims end up being coded incorrectly:

Use of outdated coding books.

Disaggregation of charges that should be handled under the same procedure code.

Over- or under-billing

Mismatched codes

Missing codes

Billing CPT codes that are not in your insurer's contract

While overbilling and underbilling can be fraudulent, they can also occur by accident. The solution is to choose a medical practice management solution that includes coding automation and is updated to reflect the latest coding requirements.  Using software that has the ability to list only the codes specific to each health insurance company can easily reduce billing time and leave no room for errors to occur.  When your staff can look up diagnosis codes and procedure codes easily, the chances of them making a mistake are greatly reduced.

#4: Duplicate Billing

Sometimes, one member of your staff will prepare a bill for a patient and then another will do the same, not realizing that the bill has already been prepared.  In that case, a double bill would result, which could mean a double bill to the patient and potentially an upset customer.

This is a problem we needed to avoid before creating HENO. With manual billing and spreadsheet management, it is easy to make duplication errors.

The solution is automation, which can create an invoice automatically and flag duplicates if someone tries to create an additional invoice for the same services and treatments.

#5: Lack of documentation

All insurance providers require documentation to pay claims. Without it, they may simply reject a claim and send it back to you, in which case you will need to provide the necessary documentation and resubmit the claim.

The solution is to make sure your staff is properly trained to recognize when documentation is required to demonstrate medical necessity. Ideally, your billing software should make it easy for you to attach the documentation at the same time you submit the claim.

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#6: Non-covered service

The patient's insurance coverage may change for a variety of reasons, such as a change in employment. There may also be limitations on the number of physical therapy visits or treatments that are covered, and when a patient reaches their coverage limit they will have to pay out of pocket. Incorrect billing to an insurance company may result in the patient having to pay out-of-pocket.