One of the most significant challenges in the healthcare industry is medical billing errors and the credit balances that result from them. These small mistakes can require significant time and effort, as billers have to communicate with frustrated patients and insurance providers. While billing errors will always occur, especially if you service a high volume of patients, you can take practical steps to reduce simple mistakes.
The Medical Billing Cycle and Credit Balances
The healthcare industry’s billing cycle is one of the most complicated; it involves multiple parties (the clinic, the patient, and the insurance provider) and consists of numerous detailed-oriented steps.
The medical billing cycle begins with the patient checking in at the office or clinic. Second, your clinic staff checks for valid insurance information before sending them in for a diagnosis or treatment. Next comes the actual billing. Using a code system, the billing staffer enters the charge for the services and equipment the patient required during the visit, and then they submit a claim to the patient’s insurance policy provider. Finally, after the insurance provider accepts the claim, they post your clinic payment.
A credit balance is any amount of money you owe to your client due to a mistake in one or more of the billing steps described above. Your patients could be entitled to a refund due to various mistakes such as the biller entering the wrong diagnosis code, system failure, or double-payments.
Catching Correcting Credit Balances
Correcting credit balances starts with detecting the error and determining what caused it. But catching and fixing billing errors one by one can be time-consuming and taxing for your billing staff, even if you have advanced electronic health record (EHR) and practice management (PM) software from a company like NextGen. Fortunately, you find tools for handling NextGen credit balances that can rectify and reduce errors, improving your billing process as a whole.
You can also work with a medical billing consulting company to help identify the cogs in your billing process. A consulting firm can provide staff augmentation and train your existing staff to process payments more efficiently but with few errors. They’ll help your billing staff pinpoint credit balance errors early on to avoid filling up your backlog and breaking state law by not paying back your patients on time.
Common Errors That Lead to Credit Balances (And How to Prevent Them)
Whether or not you work with a consulting company to improve your billing workflow, the first step to minimizing credit balances is to figure out where and when the errors occur.
Depending on how your clinic operates, your staff’s experience, and the type of software you use to manage your billing cycle, there are many ways a single operation could go wrong and result in credit balances. A few common mistakes that lead to over or underpayment include:
- Incorrect Adjustments– As a patient’s diagnosis and treatments change, the check-in for the medical bill also needs to change. That’s where an error in the patient’s information could occur. You can avoid this error by double-checking each adjustment and confirming with the patient and their insurance provider.
- Duplicate Claims– There are many reasons for duplicate claims, such as billing system errors, human errors, or poor synchronization of data between registry devices and accounts. Running a system that flags duplicate payments from patients and insurance providers can prevent duplicate claims and payment errors.
- Insurance Provider Payment Error– The error could originate from a patient’s insurance policy provider, either as a staff or system error where there’s a duplicate payment that requires a refund. Preventing this error is slightly more complicated, as you need to contact the insurance provider and confirm each claim and payment information.
- Cost-sharing Errors– By sending the payment receipt to multiple parties, like in cost-sharing—to the patient and their service provider—the surface area of possible errors increases. A mistake can result from anything from a human error to declined banknotes and switched accounts, and you” need constant monitoring to detect and flag faulty claims.
- Primary and Secondary Carrier Mix-up– There could be a mix up between the primary and secondary insurance carriers where one payment gets registered as “received” in place of the other. Similar to duplicate claims, billing system software could flag inconsistent payment and claim information.
Consulting Credit Balance Experts
You can avoid most credit balance errors by keeping tabs on the billing cycle from start to finish, fixing errors, and contacting the involved party as needed. Purchasing new software, setting up a working system, and training your staff on how to use it will take significant time and resources, but a consulting company could help with the job and pay off in no time by reducing time-consuming credit balances.