How to Avoid Overbilling and Misbilling?

overbilling and misbilling
June 23, 2017

Posted by MedbillingExperts / 0 Comment

Medical billing is complex, tedious and challenging. After all, what else can you expect from a task, wherein you have to keep track of so many different rules, which are ever-changing? Obviously the chances of committing mistakes are high. And to make matters worse, in many cases, people might not even be aware of the fact that they are committing mistakes. But irrespective of whether your billing mistakes are deliberate or inadvertent in nature, you have to face consequences. That is why it is beneficial to have a complete understanding of the don’ts of billing, before they eat up a major chunk of your bottom line.

With that thought, let’s dig deep and understand the two biggest billing mistakes — overbilling and misbilling — and ways to avoid them.

Overbilling

Overbilling is a deliberate tactic that is discreetly used to receive higher payments. And there are three ways through which this happens:

Upcoding: This is the practice of entering incorrect billing codes of a more exorbitant service rather than the one that is actually delivered.

Overcharging: This is the practice of unnecessarily charging for additional units for services provided or adding codes for services that were not delivered.

Utilization abuse: This is the practice of scheduling unnecessary visits or providing inappropriate services.

How to Avoid it

As mentioned earlier, overbilling is intentional in nature, and the only way to keep a lid on it is by incorporating appropriate monitoring mechanisms, which ensures that there is no deviation in delivering or billing medically necessary services specific to individual patient’s treatment plan.

Misbilling

Misbilling is caused due to input oversights, timing issues and manual errors.

They generally occur when your practice falls short with regards to:

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

How to Avoid it

The easiest way to avoid misbilling is by streamlining your billing workflow using the following steps:

1. Carry out internal billing audit on a timely basis
Conduct internal audits at regular intervals of time and keep a track every process starting from documentation to coding and claims creation. Extensively scrutinize and get to the crux of every claim denials, and take necessary actions to fix the problematic area.

2. Leverage billing services
Third party billing services can be of great help in fixing your billing woes, including misbilling. Hence start making them a part of your practice.

3. Level set your team
Make sure that every member of your team is on the same page by engaging and interacting with them on a regular base.

4. Examine every single denied claim
As per recent studies, only 40% of healthcare practices appeal denied claims, which is unacceptable. Many a time’s claims can denied due to the errors committed at the payers’ end. Hence it is always advisable to inspect the denial reasons for every single claim.

Misbilling and overbilling are no longer a petty or inconsequential mistake. They are widespread and are occurring way more than any of us anticipated. Hence instead of turning a blind eye, make sure that these mistakes do not blow out of proportion and take you down by implementing the necessary steps.

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