Common Medical Billing Problems

Common Medical Billing Problems

One of the most common errors in medical billing when it is handled in house at the physician’s office is a completely avoidable one. It’s called Up-coding, Undercoding, and Over-coding.

Basically, correctly done coding is when the CPT-4, matches up to the correct ICD-9 or diagnosis. Sounds easy enough until you get into the sheer myriad of services available for medical billing purposes.

What you need to be careful of is Up-coding that involves submitting CPT code(s) for a more extensive service or procedure than what was actually performed, or for submitting CPT codes for non-covered or non-chargeable services.

Over-coding another biggie that can get your claims kicked back. It involves submitting several CPT codes instead of one code that represents all the procedures performed (also known as unbundling).

Undercoding a process in which providers report CPT codes denoting a less extensive service to avoid an audit. This can result in a loss of revenue and potentially trigger the audit you were trying to avoid.

All of the above situations create kickbacks of claims and disrupt physician’s cash flow with their reimbursements. Regardless of who actually does the medical billing coding, the physician who signs the claim form is legally responsible for the codes selected and submitted to the carriers/clearinghoues for payment reimbursements.

Make sure your medical billing forms are filled out correctly before you submit them and watch for the various forms of coding that don’t get your client paid!

View all Articles by: Melissa Clark, CCS-P