How Medical Billing Discrepancies Affect Your Practice & Patients

Most patients will look at their medical bill, add their credit card to your practice’s online portal, and never think about their bill until they see it on their bank statement. However, errors can slip past medical providers and insurance companies, and patients are the last people you want to second-guess your services and professionalism.

This brief article highlights how medical billing discrepancies negatively affect your healthcare practice and patients and how to improve your billing process to reduce mistakes and improve your reputation.

What Are Medical Billing Discrepancies?

Medical billing discrepancies include:

• Duplicate charges.
• Billing for services not rendered.
• The upcoding of charges (coding for a more serious treatment) on medical bills.

These can result from simply inputting the wrong service code or using outdated codes during billing. However, they can also come from negligent or poor business practices to charge patients or insurance companies more money for a typically inexpensive service.

Either way, these billing discrepancies can cause patients to lose faith in your practice, leave negative reviews online, and possibly pursue legal action. While one billing discrepancy from a single patient won’t shut down your healthcare practice or impact your revenue cycle, one mistake can reveal an inefficient billing process that can spiral into mayhem.

Read about: Credentialing In Medical Billing: Importance, Advantages, & More

How They Affect Your Practice

Medical billing discrepancies aren’t isolated to the bill sent to patients after treatment is provided. Insurance companies can deny medical bills with discrepancies that make the provided treatment unclear, vague, or appear outside the patient’s coverage, even if it is. This can affect your practice in various ways, impacting your revenue and ability to provide essential healthcare services.

• Revenue Loss: In practical terms, billing mistakes can translate to a significant financial toll, with practices experiencing an average revenue loss of 5-10% due to billing errors. Such financial setbacks can compromise a physician’s ability to provide high-quality patient care and, in extreme cases, may even threaten the viability of the practice
• Time and Resources: Billing discrepancies can consume valuable time to correct, possibly impacting your practice’s ability to provide quality patient care. If staff or doctors spend most of their day fixing tedious mistakes, they can feel overworked, burnt out, and stressed, leading to a drop in productivity and efficient time management.
• Reputation: Patients usually look least forward to the billing part of their treatment, especially if they have higher deductibles or coinsurance. And if they notice a billing discrepancy, it can be just enough for them to leave your practice and find another. They can also leave reviews about their negative experience online and turn others away from your practice.
• Legal Issues: Upcoding and other forms of fraudulent billing can result in fines, legal action, and loss of medical licenses. These might come from patients, insurance companies, or government programs like Medicare and Medicaid.
• Audits: If your practice grapples with frequent medical billing errors and inconsistencies, it could draw the attention of auditors. Both government entities like the Centers for Medicare and Medicaid Services and private insurance companies are more likely to closely examine practices with a track record of billing inaccuracies as part of their efforts to prevent fraud.

How They Affect Your Patients

Medical billing discrepancies can impact your patient’s finances, credit scores, and peace of mind. In cases where they cannot afford their next round of medical services, patients are less likely to continue their treatment, which can harm their health. Considering that most people have full-time jobs and insufficient time to engage in back-and-forth interactions with insurance companies and healthcare providers to resolve billing errors, this situation can lead to unpaid claims and treatment delays.

It’s important to note that the No Surprises Act protects patients from surprise medical bills exceeding $400 beyond their Good Faith Estimate, higher charges for emergency care from out-of-network providers, and increased charges for care received from out-of-network providers at in-network facilities.

How To Reduce Medical Billing Discrepancies

Even small mistakes in the patient’s details can cause problems with insurance claims. To prevent these errors, make sure to update the patient’s information in the electronic health record (EHR) during each follow-up appointment. Additionally, the rules for medical billing and coding are always changing. Even if you have staff in your office handling billing, keeping up with the latest changes can be challenging but necessary to avoid discrepancies.

Before submitting claims, it’s essential to ensure everything is in order. Check that you’ve accounted for the right amount of billable hours, obtained signatures from clinicians or supervisors, and followed state and national guidelines. If the workload is becoming too much, consider partnering with a medical billing company that can follow up on and appeal denied claims due to errors.

These dedicated teams will monitor claim submissions, identify errors, and make necessary corrections. They can also work with and educate your medical staff to ensure that the initial coding process is smooth and that claims are processed correctly from the start.

Read about: The Benefits Of Outsourcing Your Medical Billing

Contact Hansei Solutions For Ambulatory Surgery Billing

If you want to know more about reducing and eliminating billing discrepancies, contact Hansei Solutions. Our medical billing team can ensure billing discrepancies are caught before they’re sent for payment, safeguarding your time and resources toward treating patients and providing the highest levels of care. If you’re unsure if your practice has an inefficient billing process, one of our RCM team can review your practice and provide a free demonstration of our solutions. Don’t let billing discrepancies hold down your business. Call today and partner with professionals dedicated to helping you grow and improve your practice.