Chapter 2: Insurance billing mistakes to avoid

As you will soon find out, the road to remuneration is not without its dead-ends, delays, and roadblocks. In this section, we will discuss the best strategies for avoiding billing accidents and payment postponements.

Billing is annoying, but getting paid makes up for the hassle. Let that be your motto as we discuss the not-so-pretty side of billing.

Common billing errors

In the last section, we went over how to correctly bill a client or an insurance company. Now, we are going to dive into what you do not want to do when billing.

Duplicate billing

This happens quite a lot. Someone in your office files a claim and then someone else files the same claim, not aware that the claim has already been reported or even paid in full. Duplicate, or double, billing can occur with procedures, supplies, and medicines. These claims will come back rejected. To avoid the hassle, make sure billing responsibilities are clearly delineated in your office.

Simple errors

Any typo or misspelling can turn into a billing nightmare. Insurance companies can reject a claim with a misspelled name or incorrect date of birth. Transposing street address numbers could mean that your patient does not receive billing notices in a timely manner. Here are the most common simple errors:

• Incorrect client information (name, date of birth, address, gender, insurance identification number)
• Incorrect insurance provider information (name, address, plan type, policy number)
• Incorrect provider information (name, address, phone number, email address, identifier)
• Incorrect quantity (adding an extra 0 or transposing numbers of services provided)
• Always check (and then double check) client information to ensure that mistakes such as these are not being made.

Incorrect codes

There are thousands of codes you have to juggle — CPT, ICD-10, and DSM 5, just for starters. It is easy to choose the wrong code but it can be a costly mistake.

Not enough documentation

Have you included what you did and why? Did you include your diagnosis and a list of symptoms along with your billing paperwork? If not, an insurance company can deny the claim.

Unbundling

Similar to overbilling, unbundling occurs when you bill separately for each service instead of billing under one code. Unbundling usually happens when a provider is hoping to get paid more for services rendered so they charge a la carte instead of under an inclusive package code.

Undercoding

Undercoding is when you use a CPT code that represents a lower priced treatment or a less severe diagnosis. While this can be done by mistake, undercoding is often intentional. A provider intentionally leaves out a service rendered as a way to save money for the patient. Providers may also undercode to avoid auditing from an insurance company. Regardless of the reason it is done, undercoding is illegal.

Upcoding

Upcoding is when you use a CPT code that represents a higher priced treatment or a more severe diagnosis. Though, upcoding is illegal (and unethical), it is not always done with a malicious intent. Upcoding often results from having an untrained staff member. This highlights not only the benefits of having well trained billing staff, but it also shines a spotlight on the many negative impacts of having poorly trained staff.

How to avoid billing nightmare

Be vigilant

Be on top of the billing for your private practice. Create a payment policy and keep a strict schedule for billing.

Train your staff

Make sure that your staff understands the basics of billing. This will not only help you make more money in the long run, but it will also reduce your risk of getting into legal and ethical problems from careless mistakes.

Keep up to date on billing and coding

Stay updated about current coding and billing practices. Sign up for newsletters from your state accreditation board, insurance companies, and industry leaders. This will allow you to have the most up to date information. Following blogs, such as TheraNest’s also gives you access to the latest in therapy billing practices so you can stay on top of your business.

Follow up on billing claims and overdue balances

Do not let claims fall through the cracks. Stay on top on claims every month. Do not let a self-pay bill go longer than 30 days before taking action. For insurance claims, get them in as soon as possible (within 90 days). Do a quarterly check for overdue balances. Timely filing is essential to getting paid for the services you provide.

Want to keep learning about insurance billing? Learn the basics here. Or go to the next chapter, where we discuss clearinghouses.

We also compiled all these chapters into a single PDF you can download here.