Common Issues in Medical Billing

Medical billing is incredibly efficient for doctors and patients, but there are still a few kinks that need to be ironed out of the workflow of many medical billers in order to make the process easier for both parties. The following covers some of the common issues found in medical billing and where these problems come from.

Common Medical Billing Issues

  • The Bill Coding Isn’t Done At The Highest Level – The bill coder’s job is to make sure that the code in your bill is written to the highest level of specificity. The coder must take accurate notes and abstract all information possible from your medical reports and understand the medical terminology for diagnoses/procedures in correlation to your billing. Whenever coding is undercoded or done at a general level, it can lead to a denied or rejected claim – which can be very time consuming and costly for you.


  • Missing/Bad Documentation – It’s important to note that poor coding isn’t always the coder’s fault. For example, there are certain cases where the coder will not receive enough information from the provider. For instance, the provider could possibly leave out important details regarding the procedure, or the medical reports may be illegible. It’s important for coders to communicate with providers to make sure the medical data is correct to avoid confusion for all parties involved.


  • Lack Of Access To The Provider – Most coders attempt to remain in close contact with the providers they’re pulling information from. However, providers aren’t always available to remain in close contact with coders when it comes to consultation for difficult claims. This situation can result in medical information being incorrectly noted in the billing.


  • Billing Services Using Outdated Code Sets – Medical billing services prioritize three principal medical coding sets. These coding sets are updated yearly, but it’s up to the coders to learn the reorganized or new codes once they come out. Professional organizations such as AHIMA and AAPC require their members to complete educational credits every two years to make sure that members are up-to-date on the newest billing codes. It’s important for coders to have high standards and complete knowledge when notating billing information.


  • Over/Under Coding – Undercoding happens when less expensive medical services are reported instead of the services that were actually performed, and overcoding is when more expensive medical services are reported than the medical procedures that were actually performed. Although these instances are not necessarily errors on part of the coder, they can happen in certain circumstances. For this reason, it’s important to have all medical information correctly notated so that it is on par with the work performed.


  • Unbundling – Unbundling is much like under/over coding, but it is more of a fraudulent practice that it is an error. Being much like upcoding, unbundling is essentially false reporting that benefits the provider – at the expense of the payer. As most medical billing procedures are operated under one umbrella code, unbundling is when coding is done separately to benefit all parties involved (in exception of the payer). This fraudulent case can be very rare, but it’s easy to spot .


About Right Medical Billing

One way to ensure that common issues such as these do not arise in your practice, is to hire a specialist from one of your local, reputable medical billing companies, such as Right Medical Billing. With more than 30 years of combined experience, RMB’s staff members have the knowledge, experience, skillset and dedication to provide you with the quality medical coding and billing you need. RMB takes the time to learn about your practice’s specific needs. Right Medical Billing offers much more than certified coding: We partner with our clients, providing training for staff members and patient billing support. Our ultimate goal is to improve your overall billing practices and insurance claim acceptance rate to increase your revenue.  If you wish to improve the workflow and revenue of your practice today, contact Right Medical Billing and speak with one of your specialist to see how we can help you and your practice improve.

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