Overcharging or double billing causes delays in reimbursement from insurance companies. This can also result in charges of insurance fraud. In some cases, more commonly seen in a hospital setting, patients are more likely to be charged for medicines or services that were never received. Or, they may be charged for a service that is more complicated or rated higher in insurance terms than they received. “Upcoding” is the medical billing term and is a form of medical billing fraud.
Patients have been denied care if there is an outstanding balance at the physician office when there is a problem of reimbursement even if the issue is because of inaccurate billing practices. Regardless if the dispute is between the office, the patient or a third party payer, the results are unnecessary delays and billing problems.
Another problem is when the claim is rejected when services are charged over and above the average level for that type of service. Meaning that insurance companies have preset levels of the amount they will reimburse depending upon the charges from the physician office. If a physician office attempts to charge more than the amount that has been negotiated between themselves and the payor, it can result in a delay of payment or complete rejection of the claim.
These are a few of the more common billing issues faced regularly by insurance companies, physician offices and Coders. It is the responsibility of the medical billing and coding specialists to eliminate the number of errors in their work and improve their reimbursement potential. When in training one must obtain adequate medical billing training and paying attention to even the smallest of detail, so that you may excel in this position as well as keeping...