5 Medical BillIng Problems and The Solutions
1. Not using current code sets.
The International Classification of Diseases, Tenth Edition (ICD-10) is a clinical cataloging which determines a patient’s diagnosis, which went into effect for the U.S. healthcare industry on Oct. 1, 2015. Even though this was a nationwide change, this is still very new to many physicians and could lead to claims being denied for improper diagnosis, or using the wrong diagnosis. Example ICD-9: 659.54 vs. ICD-10: O09.512. ICD-10. If you received a bill that got rejected due to improper diagnosis, I would call your physician and have them convert the old diagnosis to the correct model.
2. Duplicate Billing
Duplicate billing happens when multiple services or procedures get billed several times. An example would be if you get admitted to the hospital and the Dr. states that you will need an X-ray and tells the nurse and they both end up putting in a charge for the service without knowing the other one had already billed. You will be able to see errors like that on an itemized bill. If you do, you can easily have it taken care of by requesting an account audit!
3. Medical visits not billed to your insurance
A trip to the ER, becoming a new patient, forgetting your insurance card, or having new insurance at the beginning of the year are all very highly likely scenarios that your insurance may not be billed. If you receive a bill from any physician that you can noticeably tell does not have your insurance information on it, more than likely was not processed through your insurance. Also, make sure to update all your physicians with your most current insurance information at the beginning of each year to ensure they are not sending claims to your old doctor.
4. Incorrect patient information
Even the slightest misspelling of your name can determine whether a claim is approved or denied through your insurance. When having any sort of medical treatment, make sure to confirm that ALL spelling is correct and that your Date of birth matches.
5. Lack of Medical Necessity
If your provider fails to submit all proper documentation to the insurance company for claims that require additional information, you could be held responsible for those charges if your provider does not complete their request on time. In a situation like that you need to reach out to your physician and request, they take care of this immediately to have the claims processed correctly.