Medical Billers Clean Up Claim Errors

By Manny Sidhu


January 31, 2020

Using a third-party service allows for correction of coding mistakes, possible instances of unbundling and upcoding. A third-party billing service catches errors before a practice’s bills are submitted to the insurance company protecting the practice from inadvertently committing fraud, especially as these companies like Prospa Billing are the ones who check over bills and only employ expert coders and billers who are kept up to date on any governmental changes in regulations with HIPAA.

Outsource Your Back Office

Medical billers are like clean up batters, 4th in the lineup. These are the people who are responsible for ensuring consistency and accuracy between what the practice did and what it is billing. Harried staff can easily make a simple mistake if the office is shorthanded and that can result in charges of fraud being brought against the physician’s practice.

Common Billing Errors

Pre-authorization, especially for Medicaid is vital or repayment, as insurance companies want to be sure they are paying the correct amount for the procedures done and no more. Billing Medicaid is a sure way to draw close attention to the practice, there are so many stories in the news about doctors who over-charge and under-perform medical services who are being sentenced to time in prison because willfully doing that is highly illegal.

Failing to obtain authorization can cause a declined payment even if the procedure was performed, these types of procedures must be pre-authorized. Failing to apply any appropriate modifiers to the proper medical diagnosis codes can result in denial of claims. It is important to get the proper diagnosis, treatments, and symptoms and because the diagnosis does not match the patient it can result in a denial of the claim.

Entering the Correct Data

Billers must check that each different insurance companies require different data and then ensure all pertinent data is entered correctly using the correct codes. Some companies that still use paper documentation demand that paper billing requires additional information attached to the claim form like medical history or records, an itemized statement of procedures performed. In addition, proof of the injury and the explanation of benefits.

For experts, this is all simple and done every day, and if a practice is struggling, maybe it is time to speak to a professional third-party billing entity like Prospa Billing. Billers are the last hands that touch a claim before it is submitted they need to ensure it is a clean–claim, which means it is submitted accurately in accordance with the billing guidelines of the insurance company and the federal government. 

The Most Common Errors

Any claim missing information is cause for denial, the most common items left off a claim are the date of the accident, date of the medical emergency, and date of onset. Be certain to get the patient history so that these are not overlooked or submitted blank.

The person in the medical practice in charge of billing is a specialist, one who needs to learn the changes that are implemented every year. If you have a medical practice and are tired of replacing the coding books annually, having to train staff and fill in when staff calls out sick, make it easier on the practice, outsourcing your medical billing to an entity that promises a 20% jump in revenue within 90 days sounds like something that would pay for itself, and a great idea. If this is something that interests you, contact Prospa Billing by calling (844) 663-3686 or, request a consultation online and see how using a specialized billing expert can improve your bottom line.

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