Physicians depend on medical billing and coding departments to submit claims to insurance companies. Poorly managed processes affect not only practice revenue but also patients. Patient statements are generated based on what insurance companies do not cover. Reviewing statements before they are sent out to patients can help detect errors if any and improve customer satisfaction in addition to preventing delayed payments, costly fines, and loss of revenue.
Errors that Result in Wrong Statements
Before the statement is sent to the patient, ensure that the following errors have not been made:
- Incorrect patient information: This can include incorrect entry of insurance identification number and wrong name spellings. Such errors can lead to a claim denial or a full amount sent out by the patient’s health plan.
- Duplicate charges: The statement should be checked carefully for duplicate charges. This is necessary to make sure that the patient was not billed twice for a single service or procedure. This can be prevented with itemized billing.
- Billing for incorrect quantity of medication: A simple mistake which involves placing an extra ‘0’ at the end of a number by the medical biller can result in the patient being charged extra for an incorrect quantity of items or medications.
- Operating room and anesthesia time: If the patient underwent surgery, the time spent in the operating room or under anesthesia has to be correctly entered. Billing would vary based on minutes and mistakes in entry of the time spent would result in significant differences in the bill.
- Canceled tests or procedures: Make sure that the statement does not include amounts for canceled tests or procedures.
- Incorrect coding and unbundling of charges: Incorrect diagnostic and procedural codes can lead to higher medical bills. From the physician’s point of view, this could be counted as a fraudulent practice. Make sure that there was no separation of charges that should have been billed under the same procedure code.
- Errors in insurance verification: Incorrect insurance verifications could be because the insurance representative stated a wrong copay or because the the company did not provide the right information on a deductible during the initial phone call.
Things to Consider During the Statement Review
Experts recommend that the following critical points should be consider during the statement review:
- Whether the medical billing department post the amounts posted properly, and does it provide the accurate patient balance
- Whether the patient has been on the A/R list for more than 90 days. If yes, appropriate measure should be taken for collections
- Whether the patient is showing a balance because it was not processed by the insurance per the original verification
- Whether the patient is showing a balance because it was not collected up front or posted correctly in the system
Such a review can identify the true statement balance, which can be further verified for receipts for the specific dates of service. Once the receipts have been collected, they can be posted and the statement removed from the list that is being sent out. In professional medical billing companies, rigorous quality control processes ensure a good billing experience for the provider as well as patients.