Medical billing and coding are complicated procedures since even little mistakes may result in claim rejections and payment delays. Can you be sure about how accurately your medical billing department files all medical claims? Even a highly trained and experienced team may make mistakes.

Medical billing and coding errors increase claim rejections, payment losses, and risk of audits. This type of frequent error may have a detrimental effect on your connection with patients. In the modern healthcare industry, the medical coding system is quite complex, which makes errors easy to occur.

Claims rejected due to coding mistakes cost the United States around $20 billion annually. Lost or delayed reimbursements are only a portion of the problem with claim denials. The other is the expense of reworking a refused claim. Instead of incurring the costs involved with getting a clean claim, many firms would prefer to write off unclaimed claims.

So how to avoid such denials and claim rejections? By understanding and noting the common clinical medical billing claims errors. Here are some of them: 

Common Clinical Medical Billing Claims Errors To Avoid

1. Missing Patient Data

The majority of medical billing errors result from missing information on filed claims. Incomplete data, such as the accident’s date, the patient’s full name, and the date the patient requested emergency care, are frequent causes of medical billing problems. Double-checking all entries before filing the claim is of utmost importance to prevent rejection. Hence, using a portal to collect and save patient records simplifies the maintenance of vital information.

2. Claim Not Filed Within The Allotted Time Frame

In medical billing, missing the deadline for filing claims is among the other critical medical billing claims errors. When completing a claim form, the first day of the patient’s treatment is the beginning date. Hence, claims must be made within the timeframe specified by the medical insurance company and not be filed past the deadline. 

3. Wrong Patient Data

Wrong patient data is among other common clinical medical billing claims errors. Inaccurate spelling of the patient’s name, incorrect date of the birth, and mistakes while entering the patient’s insurance information often lead to a greater percentage of denied claims. The policy number, the payer’s identification, etc., must be accurate and sent to the correct payer. .

Although time-consuming, checking these areas and the relevant patient data and insurance details is crucial. Further, you may avoid these errors by employing specialized medical billing and coding software. Verifying all information submitted minimizes the number of claims refused.

4. Coding-Related Concerns

The biller or coder’s obsolete or incorrect coding may also result in denied claims. Utilizing outdated code manuals or superbills will lead to revenue loss. Further, insufficient documentation will also count as clinical medical billing claims errors. When coding and filing claims, it is essential to bill only documented expenses. Carriers perceive services as not being done if they are not recorded.

5. Upcoding 

Upcoding happens when insurances are billed for more complex treatments than they got or for treatments they didn’t receive. Also, upcoding mistakes may occur if a billing department staff commits an error while inputting diagnostic and treatment codes or if the staff is unclear of the physician’s data.

6. Patient Eligibility

Among most clinical medical billing claims, errors are not verifying the patient’s eligibility. Determining the patient’s entitlement to covered and non-covered treatments is vital. It is simple to upgrade the insurance details frequently. When a patient receives a service, it is imperative to verify their eligibility to confirm that the patient’s plan covers the treatment.

7. Necessitates a Referral or Prior Authorization

Referrals and prior authorization are sometimes necessary, and it is crucial to understand the distinction between them. The primary care physician issues a referral and refers the patient to another healthcare professional for treatment or diagnostics. The payer providing the required service(s) provides authorization in advance. Carriers acknowledge that receiving prior authorization is not an assurance of payment. The filed claim must:

  1. State the necessary medical necessity.
  2. Have the correct filing carried out.
  3. Include approvals or references of the referring or approved physician.

Final Say

Even a small human mistake might result in a claim rejection in medical billing. New Medical England Billing‘s in-depth knowledge of the claim structure facilitates more direct error checking. We monitor filed claims with frequent follow-ups, allowing you to determine the reason for rejection and resolve the problem.

With the assistance of our superior medical billing outsourcing services, you will be able to handle the complexities of medical billing and coding with ease. Moreover, we assume responsibility for controlling and preventing common clinical medical billing claims errors.


Need more information or have questions on any type of billing we do?

Affiliates of VSS Medical Technologies

Sign up for company updates and latest news from NEMB.

Get In Touch 


888 - 771 - 6115
508 - 297 - 2068

19 Norfolk Avenue
South Easton, MA 02375


©Copyright 2024 New England Medical Billing Group LTD. All rights reserved.