Medical billing is intricate, challenging and time-consuming. After all, what can you expect from something which is governed by so many different rules that are in a constant state of motion? Obviously there is lot of scope for mistakes. And to take matters worse, in many cases, people might not even know that they are making mistakes. But irrespective of whether your billing blemishes are accidental or intentional in nature, you have to face consequences in the form of claim denials, revenue flow disruptions or even worse, a big dent to your reputation. That is why it is beneficial to have a complete understanding of the dos and don’ts of billing, before those don’ts eat up a major chunk of your bottom line.

With that thought, let’s dig deep and get a thorough understanding of the two most common ways in which practices mess up their billing: over-billing and misbilling.


Over-billing is an intentional tactic that is tactfully used to obtain higher payments. And the general ways in which this happens is as follows:

Up-coding: This occurs when practices enter incorrect billing codes of more extensive and costly services rather than the ones that they have delivered.

Overcharging: Just like up-coding, overcharging happens when practices charge for additional units for services provided or add codes for services that they didn’t perform at all.

Utilization abuse: This happens when practices schedule unnecessary visits or provide inappropriate services.

How to Avoid it

Over-billing in most cases is intentional in nature. Hence the only to keep it in bay is by putting in place an appropriate monitoring mechanism that ascertains that there is no deviation in delivering or billing medically necessary services specific to individual patient’s treatment plan.


If your claim denial rate above 4%, than misbilling, which includes manual errors, timing issues and input oversights, might be the reason for this apathy. This type of error typically occurs when your practice falls short with regards to:

  • Identifying correct billable codes
  • Coding to the highest level of specificity
  • Generating clean claims

How to Avoid it

The easiest way to keep a tab on this kind of error is by cleaning up your billing workflow. You can achieve this by following the below mentioned series of steps:

1. Conduct Regular Internal Medical Billing Audit

Carry out regular internal audits and keep a tab every process starting from documentation to coding and claims creation. Thoroughly scrutinize every denied claim to get to the root cause of every denial and put in appropriate mechanisms that corrects the problematic area.

2. Opt for Billing Software or Services

Medical billing software or services can be of great help to fix any type of billing woes, including misbilling. Hence start arming your practice with this type of software or services.

3. Level-set Your Team

Make sure that each and every member of your team is on the same by interacting with them on a regular base. Talk about the typical issues that are hampering operations and their adverse effects on your business. Then, outline the measure that they should take to keep such problems at bay and if necessary be open to the idea of providing additional training.

4. Inspect Every Single Denied Claim

As per recent studies, less than 40% of providers appeal denied claims, which is unacceptable. There are many instances in which claims are denied due to the mistakes committed at the payers’ end. Hence never hesitate to inspect the denial reasons for every single claim.

Overbilling and misbilling are no longer a trivial mistake. They are very rampant and are occurring way more than any of us anticipated. Hence instead of turning a blind eye, make sure that these mistakes do not grow out of proportion and take your business into drains by implementing aforementioned steps.


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HIPAA Compliance


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