Medical Billing Errors Cost Physicians Billions

Given that as much as 80 percent of medical claims submitted to insurance companies include mistakes estimated at $68 billion and that about 55 percent of evaluation and management claims are coded wrongly, Practice Management Institute is seeing an increase in employees getting specialized training and certification from the company.

In a press release, Practice Management Institute said incorrectly coded claims resulted in $6.7 billion in improper Medicare payments. As a result, providers looking to prevent costly mistakes are increasing the training standards of administrators and are looking to hire those that are already certified.

“It’s critically important that providers have well-trained staff. The physician needs to have confidence that their personnel are running the business correctly so they can focus on quality patient care,” said David Womack, president and CEO of PMI in the release.

According to PMI watchdog agencies, enforcement and penalties are on the rise, which creates a risky environment for doctors. Tighter screening measures, thanks to the Affordable Care Act, have resulted in 17,000 medical providers losing their ability to bill Medicare. On top of that, doctors bear the responsibility for all claims billed under their provider name, and the signature of the doctor on any and all claims is used as verification of the accuracy and legitimacy of claims.

Physicians dedicate their careers to quality patient care; most have had little exposure to the increasingly complex world of medical claims management. They rely on their billing and administrative staff to stay on top of the guidelines set forth by Medicare and third parties. PMI helps providers adopt higher training standards with specialized courses and certification exams that address these high-risk areas of practice administration,” Womack said.

He noted that taking steps to successfully train and certify staff in these areas means physicians are more likely to submit accurate claims and receive correct payments for their services, ensuring that practice liability is minimized.