10 Medical Billing Mistakes Costing Your Practice Lakhs Every Month (And How to Fix Them)
Imagine a practice that is losing ₹2-3 lakhs every month. This is a lot of money. And it is happening without anyone noticing. This sounds very alarming.
That, unfortunate as it may have to be, is what is happening with medical practices across India. This is a trouble for medical billing errors in these methods. They are like profit killers.
While you and your team are busy seeing patients, small billing and coding errors are quietly siphoning off dollars from your practice. 80% of medical bills have at least one error, studies show. Also many claims are denied. In health care practices, 15-25% of them. It's medical billing errors that are really hurting these practices.
The good news? The good news is that most of these mistakes can be avoided once you learn what to watch out for.
In this new guide, we will explore 10 mistakes that cost medical practices money. We will tell you how to avoid these errors. This information will be useful for you if you own a clinic or manage your practice, and even if you handle the billing work yourself. It will assist you in getting compensated for the performance of your employment. Make more money.
Problems With Medical Billing That We Can Solve---This is the problem with medical billing mistakes. Our job here is to assist you in correcting these so that you can collect from those who owe you. Medical billing is important. We want to help you do it right.
1. Incorrect or Outdated Patient Information
Simple things like a wrong name spelling, insurance policy numbers mashing up with wrong birth date or old details of their insurance can cause the claim to be blocked in one go.
As per industry data many of them denial claims. Up to 25%. Happen because of patient information.
✓ Patients update their information with insurers, but forget to share it with your clinic
✓ Front desk staff entering data manually can make errors. Your medical records at your clinic donot ever get updated with another check up each time you visit
✓ Patients use a nickname rather than their full legal name
✓ Verify patient demographics at all visits not just the first visit
✓ Patients are asked to present their insurance card and verify demographic information
✓Employ electronic tools that confirm insurance information in real-time
✓ Confirm that the name on file is the same as on the patients ID
✓ Two sets of eyes to confirm important pieces — such as policy numbers
2. Not Verifying Insurance Eligibility Before Treatment
Insurance plans can lapse, coverage levels change and the actual procedure might not even be covered by the insurance plan in the first place — provide services to a patient who is no longer eligible for reimbursement, and there is little left but rejected claims and unpaid bills. This places your practice in a position of writing off the debt or trying to collect it directly from the patient.
✓ Assumes the coverage from your most recent visit is active
✓Does not have time to check on coverage during busy clinic hours
✓ Patients change insurance plans without notifying the clinic
✓ Please see changes in company insurance when working patients move
✓ Require eligibility verification at each visit opportunity, not just for new patients
✓ Confirm coverage 1 or 2 days prior striking.
✓ Verify active coverage, but also verify deduction amounts, co-pays and procedure specific coverage details
✓ Save time using an automated eligibility verification solution
✓ Results of document verification in patient chart
3. Missing or Incorrect Medical Coding
Submitting claims with incorrect ICD-10, CPT or HCPCS codes or choosing the wrong codes and not billing for services that were performed generates claim rejections and lost revenues. Even the most seasoned coder can make coding errors when faced with more than 70,000 ICD-10 codes.
✓ Medical codes change every year but staff are not trained in changes
✓ Inadequate documenting clinical facts to back the accurate code
✓ Coders making assumptions and guesses about codes rather than getting clarification from the doctor.
✓ Specialty-specific knowledge of coding
✓ Invest in ongoing training for your coding staff on annual code updates
✓ Use medical coding software with built-in updates and error-checking
✓ Ensure doctors provide clear, detailed documentation for every procedure
✓ Consider outsourcing to certified medical coders who specialize in your practice area
✓ Conduct regular internal audits to catch coding errors before submission
4. Failure to Obtain Prior Authorization
Insurance companies often force doctors to get permission for many diagnostic tests, referrals to specialists, surgeries and expensive medications. By treating these services without prior approvals (which are then systemically denied), you have performed hours of uncompensated work.
✓ Staff do not know which procedures require pre-authorization
→ Urgent situations where staff go ahead without permission to prevent delays
✓ Different insurers have different authorization requirements
✓ No tracking mechanism for authorization requests and approvals
✓ Keep an up to date list of procedures covered by each insurance company that needs a prior authorization.
✓ Assign staff members responsible for the management of authorizations
✓ Begin authorization earlier — not just on day of service
✓ Maintain these authorization approvals in detail with reference numbers
✓ Pursue outstanding authorization requests to avert last-minute cancellations إ
5. Missing Claim Submission Deadlines
Insurance companies will have a specific time frame—usually 90-180 days from the date of service—for you to submit a claim. Be late, and your claim is automatically denied; no matter if it is true or honest. This means thousand rupees loss per month in revenue for many practices.
✓ Implement internal deadlines for submission (e.g. 30 days) which is earlier than payer deadlines
✓ Use automated system reminders and tracking systems to identify imminent due dates
✓ Submit claims weekly in batches rather than waiting for month-end accumulation
✓ Track claim aging reports and identify and fix claims that are being delayed
The Bottom Line: Prevention is Cheaper Than the Cure
Medical billing errors are expensive, however they're also almost completely avoidable. It is better to set the right systems, processes and expertise upfront than chasing errors post factum.
Consider these statistics:
Habits that use correct verification procedures experience clean claim ranges better than 95%
✓ Managed denials decrease from more than 20% to below 10% in systematicdenial management
✓ Days in a receivable come down by 30–40 days with accurate coding and submission on time
✓ 15 – 25% bump in revenue when errors are fixed for good
Why Many Practices Choose to Outsource Medical Billing
There is a lot to invest such as training, software and staff for an in-house approach to medical billing. Some progressive practices are opting to eliminate these errors altogether by working with specialized revenue cycle management companies.
Revno RCM : Revno RCM is a company that helps healthcare providers get the most out of revenue generation, reducing administrative burden. Trained Medical Billing professionals take care of everything from verifying patient eligibility to denial management while your staff can be focused entirely on delivering more care.
We offer a wide range of medical billing services including:
✓ Real-time insurance eligibility verification
✓ Certified specialists providing accurate medical coding
✓ Prior authorization management
✓ Per-submission claim scrubbing and error detection
✓ Strong denial management & appeals
Financial Performance meetings on a monthly basis with actionable recommendations
✓ Processes and Data Security compliant with HIPAA
Up to you not permitting the billing errors make more losses your practice revenue. Whether you upgrade processes in-house or partner with a specialized RCM provider, taking action today will yield dividends for years to come.
