Stop losing money: A guide to billing errors and solutions for 2025

The phone rings at 5:47 PM on a Friday. Your billing manager’s voice sounds tired as she explains that a batch of claims got rejected—again. This time, it’s because of the new CPT codes that went into effect a couple months back. The weekend ahead suddenly feels heavier, knowing Monday will bring more denied claims, frustrated clients, and delayed payments.

If this scenario sounds familiar, you’re not alone. Practice owners, therapists, and other healthcare providers across the country are grappling with an increasingly complex insurance billing landscape. But here’s the thing: 2025 doesn’t have to be another year of billing headaches and lost revenue.

This guide will help ease insurance billing, eliminate costly mistakes, and create a streamlined system that works—even when regulations change. You’ll discover practical solutions that real practices are using today to improve their cash flow and reduce billing stress. If you’re just starting out, check out our previously published blog on common insurance billing mistakes here.

Why insurance billing errors cost more than you think

Every billing mistake creates a ripple effect through your practice. When claims get denied, you’re not just losing the immediate payment—you’re also spending valuable staff time on resubmissions, dealing with frustrated clients who receive unexpected bills, and potentially damaging relationships with insurance companies.

According to recent industry data, practices lose an average of 2-5% of their revenue annually due to billing errors. For a practice generating $1 million in annual revenue, that’s $20,000 to $50,000 walking out the door each year.

The 2025 regulatory landscape makes accuracy even more critical. With 420 updates to the CPT code set alone—including 270 new codes, 112 deletions, and 38 revisions—the margin for error has never been smaller. The CDC also released 252 new ICD-10-CM codes, 36 code deletions, and 13 revisions that took effect in October 2024.

The most common billing mistakes destroying your revenue

Patient information errors

Simple data entry mistakes account for a surprising number of claim rejections. A transposed digit in a date of birth, a misspelled name, or an incorrect insurance ID number can send your claim straight to the rejection pile. A recent report states that inaccurate or incomplete patient information is one of the top three reasons for rejections, alongside missing data and authorization issues.  

Coding catastrophes

With thousands of medical codes to juggle—CPT, ICD-10, and HCPCS—it’s easy to select the wrong one, and the consequences of an error can be severe:

• Duplicate billing happens when multiple staff members file the same claim, often because responsibilities aren’t clearly defined. This creates confusion with payers and delays payment for legitimate claims.

• Undercoding might seem like it helps clients save money, but it’s actually illegal and can trigger audits. Using codes that represent less severe diagnoses or lower-priced treatments shortchanges your practice and violates compliance requirements.

• Upcoding is equally problematic. Using codes for higher-priced treatments or more severe diagnoses than actually provided can result in fraud accusations and serious legal consequences.

• Unbundling occurs when you bill separately for services that should be coded together under one comprehensive code. This often happens when staff try to maximize reimbursement but don’t understand proper coding protocols.

Documentation gaps

Insurance companies can reject claims when your documentation doesn’t clearly support the services billed. Missing diagnosis codes, incomplete procedure notes, or insufficient detail about medical necessity create easy targets for rejection.

Timing troubles

Many insurance providers require claims submission within specific timeframes—often 90 days, though best practice is to submit within 30 days. Missing these deadlines can result in automatic rejection, regardless of how accurate your coding might be.

Building your bulletproof billing system for 2025

Step 1: Create ironclad patient verification

Your billing accuracy starts at the front desk. Implement these verification protocols:

• At every appointment, confirm patient information even for established patients. Insurance coverage changes frequently, and what was accurate six months ago might not be today. This practice can be tedious, but it’s a crucial part of efficient billing. (The right EHR can be super helpful in simplifying this step by allowing intake staff to check eligibility with the press of a button.)

• Use multiple verification methods. Don’t rely solely on insurance cards. Call the insurance company directly, use payer portals, or work with a clearinghouse to verify eligibility in real-time.

• Document secondary insurance. Many patients have multiple coverage sources, especially if both spouses have employer-sponsored insurance. Proper coordination of benefits can significantly improve your reimbursement rates.

Step 2: Master the new coding requirements

The 2025 coding updates aren’t just bureaucratic changes—they reflect advances in medical technology and treatment options. Here’s how to stay current:

• Invest in coding education. Your coding staff should receive regular training on new codes and guidelines. Consider certification programs or quarterly workshops to keep skills sharp.

• Use technology to your advantage. Modern billing software includes built-in coding assistance and error-checking features. These systems can flag potential problems before claims go out the door.

• Understand the timing requirements. Many CPT codes are time-based, meaning they apply to treatments of specific durations. Using the wrong time-based code can trigger automatic rejections or compliance issues.

Step 3: Implement systematic quality checks

Create multiple checkpoints in your billing process:

• Pre-submission review. Every claim should be reviewed for accuracy before submission. Check patient demographics, insurance information, diagnosis codes, and procedure codes.

• Regular audits. Conduct monthly reviews of your most common rejection reasons. Look for patterns that might indicate systematic problems in your billing process. (A competent RCM team can really come in handy here!)

• Staff cross-training. Ensure multiple team members can handle billing tasks. This prevents bottlenecks when key staff are unavailable and provides internal quality control.

Step 4: Optimize your claim submission process

• Submit claims within 30 days. While many payers allow up to 90 days, faster submission improves your cash flow and reduces the risk of missing deadlines.

• Use electronic submission. Electronic claims process faster and have fewer errors than paper submissions. Most clearinghouses offer real-time eligibility verification and claim scrubbing services.

• Track everything. Maintain detailed records of claim submissions, including dates, amounts, and payer responses. This documentation is crucial for appeals and audits.

Technology solutions that actually work

The right billing software can transform your revenue cycle management. Look for systems that offer:

• Automated eligibility verification to catch insurance changes before they cause claim denials.

• Real-time claim scrubbing to identify potential problems before submission.

• Integrated clearinghouse services to streamline the submission and tracking process.

• Comprehensive reporting to help you identify trends and problem areas.

• 2025-compliant coding databases that update automatically when new codes are released.

Many practices report 20-30% reductions in claim denials and rejections after implementing modern billing software. The key is choosing a system that integrates well with your existing practice management software and electronic health records.

When outsourcing makes sense

Not every practice needs to handle billing internally. Outsourcing can be particularly beneficial if:

• Your in-house rejection rate exceeds 10%. Professional billing services typically achieve rates of 3-5%.

• You’re spending too much staff time on billing. If billing tasks are preventing your team from focusing on patient care, outsourcing might free up valuable resources.

• You lack coding expertise. Specialized billing companies stay current with coding changes and compliance requirements as part of their core business.

• Your practice is growing rapidly. Outsourcing can provide scalability without the need to hire and train additional billing staff.

When evaluating billing services, look for companies that share your specialty, provide transparent reporting, and offer dedicated account management.

Preparing for ongoing changes

The regulatory environment will continue evolving. Here’s how to stay ahead:

• Subscribe to industry updates. Sign up for newsletters from medical billing organizations, insurance companies, and regulatory bodies. (Check out our very own quarterly newsletter, In Harmony! It’s full of useful information and updates designed to help you stay on top of industry trends.)

• Join professional associations. Organizations like the American Academy of Professional Coders (AAPC) provide valuable training and networking opportunities.

• Plan for telehealth billing changes. Medicare’s telehealth flexibilities are scheduled to change significantly in 2025, with most services requiring patients to be in rural areas and approved locations.

• Stay informed about value-based care. The shift toward quality-based reimbursement models is accelerating, requiring new documentation and reporting practices.

Final thoughts

Remember, improving your billing process isn’t a one-time fix—it’s an ongoing commitment to excellence that pays dividends in improved cash flow, reduced stress, and better patient relationships.

The practices that thrive in 2025 will be those that view billing accuracy not as a necessary evil, but as a competitive advantage. When your billing runs smoothly, your entire practice benefits. Patients receive accurate bills, staff spend less time on corrections and resubmissions, and you get paid faster for the excellent care you provide.

Don’t let another year of billing headaches pass by. Take action today to build the systematic, accurate billing process your practice deserves. Your future self—and your bank account—will thank you.