Don’t Make These Common Billing and Coding Mistakes

Don’t Make These Common Billing and Coding Mistakes

Mistakes in the billing and coding process can take many forms, from incorrect ICD coding to ethical violations. In this revealing article, Nitin Chhoda examines the most common errors facing billers and coders, and identifies ways to avoid them.

billing and codingBilling and coding specialists work with protected information every day. Their actions have an impact on their employer, payers and patients. It’s essential that they maintain the highest ethical standards and are cognizant of laws that could inadvertently be broken.


Billing and coding staff work with facts that are backed up by practitioners with documentation. Never assume and don’t include codes that are only implied.

Appropriate documentation must accompany every claim and support the clinician’s diagnosis and treatment. Neither should codes be unbundled to claim additional reimbursement. Codes should accurately reflect the patient encounter.

The Blame Game

If a mistake is made, accept the blame instead of trying to foist it off on another billing and coding staff member. If a problem exists in the claims process, address the situation with the appropriate individual.

Over Billing

Many practitioners record every action during the patient encounter, but that doesn’t mean every detail is billable. Only claim procedures and treatments that are supported by documentation and don’t second guess the clinician. If doubts or questions exist, clarify with the practitioner.


Some actions are incidental to specific procedures and shouldn’t be billed separately. Learn which procedures can be bundled and which ones can’t to ensure accurate billing and coding.

Ignoring Errors

A mistake can be anything from an omission or incorrect code to a transcription problem. When errors are discovered, they should be brought to the practitioner’s attention. Fix the problem immediately and submit a corrected claim. Ignoring an error can result in payments to which the clinician isn’t entitled and opens the door to fraud.


Even when claims are submitted correctly, errors can occur in billing and coding that result in over payments. The payer should be notified of the mistake immediately. Be prepared to follow the necessary procedures to return the funds. Doing so reinforces the practice as a desirable partner.

Failure to Protect Patients

Clients may be required by their insurance company to only see certain providers within the payer’s network. Failure to do so can result in costs the client can’t pay and no reimbursement for the clinician. Patient coverage and benefits should be verified by billing and coding staff before their visit.

If there’s a problem, the client can be advised of their options prior to treatment.


More payers are demanding pre-authorizations before they pay for services. Failure to obtain the appropriate authorizations or referrals can result in billing and coding claims being denied and loss of payment for the provider.

Patient Confidentiality

The law protects patient information and anyone who discloses personally identifiable data is in violation of HIPAA regulations. Penalties for violations include significant fines and jail time. It’s imperative that all staff members, including those in medical billing and coding, are aware of HIPAA laws and consequences of breaking the patient’s trust.

Unscrupulous Managersbilling and coding staff

Some billing and coding managers aren’t as cognizant of coding rules, procedures and penalties as they should be, and they may even urge those in their charge to ignore or overlook issues.

Don’t be afraid to report such matters to the manger’s superior.

Mistakes are inevitable, but they should be rectified immediately. Precautions should be taken to protect patient information and uphold the highest of ethical standards to protect the integrity of the billing and coding staff, and the practice.

Medical Coder and Practice Staff’s Ethics are More Important than Their Typing Speed

Medical Coder and Practice Staff’s Ethics are More Important than Their Typing Speed

There’s a code of ethics that automatically comes into play in medical offices and employees are cognizant of this.

Staff and medical coder are aware that they can’t share personally identifiable information with outside sources, but what they don’t realize is that a casually made comment can also break the bonds of ethics and the law.

Medicalmedical coder billing and coding specialists deal with confidential information each day.

It’s important for them to perform their tasks with alacrity, but it’s imperative that their moral and ethical standards surpass their typing speed.

Practice owners want reimbursement claims filed as quickly as possible, but they can’t overlook or tolerate a breach of confidentiality no matter how efficient the medical coder is.

Practitioners have a myriad of state and federal agencies with which they must comply or they open themselves to lawsuits. A medical coder who gossips and shares patient information with anyone else is placing themselves at risk, along with the practice owner and the entire medical facility. Penalties can be leveled through civil, state and federal agencies.

Don’t run afoul of common, statutory, administrative and case law.

There are four law classifications by which clinics’ owner, staff and medical coder must operate – common, statutory, administrative and case law. They can be confusing and vague, but it’s essential that clinicians become familiar with each.

A practice is considered common law if it’s accepted as fact by the majority of the population. Common law practices don’t have the force of a governing entity behind them.

Statutory law is legislative in nature and can be created at the local, state and federal level. Administrative law encompasses sets of rules made by government bodies or officials that allow them to administer statutory laws. Case law is made by courts when they interpret administrative and statutory laws.

The penalties for loose lips are severe.

The penalties for breaking confidentiality not only by the medical coder but the rest of the practice staff are significant, far reaching and determined through civil law if a patient decides to sue. The court can rule to award monetary amounts to clients for medical expenses, lost wages and distress. In civil cases, some practitioners choose not to go before a jury, admit no guilt, and settle out of court for a specified monetary amount.

Medical coder may find themselves facing misdemeanor or criminal penalties for their lack of discretion, as well as the clinic owner by extension.

The consequences are fines and jail time for a misdemeanor. Those who violate HIPAA standards could serve jail time for a felony. Fines in such cases have ranged from $50,000 to over $4 million.

medical coder and staffMedical coder must treat each client’s data as highly confidential, even if it seems that a particular bit of information is common knowledge.

Stay vigilant

Patients must give permission before their information is shared and they must designate with whom. Those medical coder or other members of the practice who violate HIPAA codes in any way must be prepared for the consequences.

Failure to adhere to HIPAA regulations will result in litigation that can damage a practice so severely that it never recovers.

Even if everyone, including the medical coder involved, are found innocent, clinicians will contend with a loss of reputation, clients and revenue.

No matter how skilled a coder is at efficiently submitting claims, it’s not worth the risk if he or she doesn’t come equipped with a superior set of ethics.

Medical Billing And Coding Outsourced

Medical Billing And Coding Outsourced

Medical billing and coding are indeed a very complex subject.  It is important to analyze whether your practice will need an in-house medical biller and coder or have it outsourced.

Nitin Chhoda gives some factors to consider in order to guide your physical therapy practice when it comes to your medical billing needs.

medical billing and codingOutsourcing often increases efficiency, especially in technical fields like accounting and medical billing and coding.

Within a single office, a number of practices can be serviced by a handful of highly skilled professional medical billers and coders.

They can focus all of their resources and attention on efficiency and a system that works. At a medical clinic, the primary focus is often the patients, as it should be.

Reasons to Outsource Your Medical Billing and Coding

Here are some very good reasons that a practice should consider outsourcing medical billing and coding. For the most part, the decision will be financial. But to determine whether or not it will be worthwhile for your practice to outsource can be so complex that identifying key reasons to outsource will help.

You’re New

New clinicians or health care providers have a whole host of things to worry about. How do you maintain a steady stream of patients?

Does your practice have the in-house testing capabilities necessary for the needs of the community? How do you balance the business side with patient care? How many hours per day should you be seeing patients?

Probably the top concern is how your patients are doing, how they feel about you, and whether or not you’re helping them. Managing a business at the same time as you’re learning what it means to run a private practice can be overwhelming.

Staff Turnover is High

If you are handling in-house medical billing and coding, but have to hire a new biller or coder regularly, your practice will suffer.

The learning curve for medical billing and coding is unforgiving and even a skilled medical billing and coding professional is going to be slow to start as they figure out your particular system. For practices that can’t seem to keep medical billing and coding staff members, a consistent service from elsewhere will be more efficient.

Inefficiency is Obvious medical billing and coding oursourced

Outsourcing has a couple of major benefits, and one of them is that rejections and denials are usually decreased when you outsource medical billing and coding.

If you are experiencing problems with collections and your rejection and denial rate is high, it may be time to consider giving the job to a service that specializes in getting claims accepted.

You Don’t Want to Focus on Billing

Chances are, you don’t want to think about medical billing and coding. As critical as getting paid is to the health of your practice, if you became a doctor because you want to help people feel better, billing is probably an annoying part of your job.

Not to mention the fact that an incredible amount of tech savvy and skill is required to make your medical billing and coding system efficient and effective. Many clinicians decide that the billing side is the part they don’t want to know about – they’d prefer to let someone else worry about the medical billing and coding courses so they can continue to provide a service to the community.

Medical Billing And Coding In-House

Medical Billing And Coding In-House

Whether your medical billing and coding should be in-housed or outsourced, there are certain things that are worth considering.  Nitin Chhoda shares the advantages of an in-house medical billing and coding for a small or new private practice.

medical billing and coding in-houseOne of the biggest considerations for many practices is whether or not to conduct the medical billing and coding in-house or to outsource the work.

The question tends to focus on costs, which makes sense.

If your practice can save money by hiring a company to handle the medical billing and coding for you, why hire someone in-house?

But of course, calculating how you are best served is not all that simple. The determination often depends on the size of the office, how many claims need to be filed per day, how many clinicians work at the practice, and the costs of related hardware and software.

And of course, does in-house medical billing and coding improve the rate at which your claims are accepted and paid, or will outsourcing improve collection rates?

Benefits of In-House Billers

The most obvious decision will have to do with the amount of billing that your in-house billers and coders can handle.

In a very small practice, where the receptionist can handle scheduling, medical coding, and medical billing without being overwhelmed, hiring out medical billing and coding is probably unnecessary. And there are a few benefits to having the medical billing and coding professional right there in the office with clinicians.

When you can talk to your medical billing and coding staff member directly, all the details can be accessed at any time about any claim. One downside of an off-site service is that you have less control over and less access to your billing history.

Some services will provide reporting as a scheduled service or on demand. But timing will still be hampered by the fact that the medical billing and coding staff handling your practice probably has a number of practices to worry about. The process becomes less personal.

medical billing and coding needsAnother benefit of in-house medical billing and coding is that the information only has to be communicated once.

In other words, in many ways an outsourced system will require that someone put in a decent amount of work to get the billing accomplished.

In the most efficient scenario, you could simply scan relevant documents and hope they understand what is written.

But outsourcing will not mean that all aspect of medical billing and coding will be handled elsewhere. Someone still needs to be available for communication and transfer of information.

Size Matters When it Comes to Price

As you can imagine, the larger a practice gets, the more efficient an in-house biller can be. If you have a very small office, hiring one or two staff members just to handle medical billing and coding careers will be very expensive. In a private practice, there is a fine line to be drawn between having one staff member to handle everything administrative, and having too much work for a single staff member to handle.

When staff members with lots of responsibilities get overwhelmed, all tasks begin to suffer. And when medical billing and coding suffers, the entire practice is put in jeopardy.

Medical Billing Mistakes to Avoid

Medical Billing Mistakes to Avoid

In this article, Nitin Chhoda reveals the common mistakes in medical billing and coding that can quickly impact the cash flow of a private practice.

Some of the mistakes such as illegible handwriting, use of language and incorrect details can be avoided by using an automated physical therapy documentation system.

medical billing mistakesMedical billing and coding errors, mistakes, oversights and insufficient coding represent the most costly problems that physical therapy practices face, resulting in the loss of thousands of dollars in revenue each year.

The busier the clinic, the more likely it is that the problem will occur. An EMR will help eliminate denials and late payments, but practice owners must make medical billing and coding a priority.

Insurance providers are scrutinizing reimbursement claims more closely than ever before, making it imperative that the person responsible for billing and coding be trained and knowledgeable in the specialized language of the profession and familiar with EMR practices.

Sometimes it’s the simplest codes that create denials and a professional medical billing coder can make a tremendous difference in the revenues collected.


The little things in medical billing and coding can wreak real havoc on revenues and result in denials. Identifying a male client as female, dates that don’t match, using outdated codes and not coding for a multiple diagnosis are just some of the ways therapists slow down their cash flow and generate denials. Illegible handwriting is always a problem and if the writing can’t be read, it can be deemed unbillable. Utilizing an EMR will eliminate such problems.

medical billingLanguage

Coders rely on therapists for the information needed to correctly code claims. The language and terms taught and learned in school aren’t necessarily those used in a real world practice.

It’s important for the therapist to include notes to ensure coders have enough information to bill at the highest acceptable level. Therapists should also impress upon medical billing coders the need to look at the explanation of procedures.


Physical therapists offer a wide range of services and products, but in a busy practice, some may go unnoticed when it’s time for billing. Failure to bill for ancillary services such as, medications and supplies dispensed in the office, along with x-rays and lab work that was performed, are just some of the ways that therapists rob themselves of essential income. Clinicians need to make a conscious effort to ensure that each service, appliance and aid is documented for medical billing purposes.


If the service, treatment or procedure isn’t documented, it can’t be billed. Coders can only work with the information provided, even with a technologically advanced EMR. Relying on the coder to “know” that a specific service was provided is pure folly. Document everything in detail and be clear about the type of service offered, including referrals and consultations. It may take a few extra seconds, but the extra time will pay off in greater revenues even in your medical billing.

Up- and down-coding

Medical billing for services at a higher level than documentation supports is embarrassing in the extreme. Many clinicians choose to down-code, hoping to avoid the specter of an audit, and only succeed in cheating themselves of valuable reimbursements.

Insurance Providers

Insurance providers aren’t infallible and it’s up to the practice owner to carefully oversee the explanation of benefits to catch medical billing mistakes when they occur. There’s a tendency to think once the reimbursement claim has been submitted, that’s the end of the process.

In truth, it’s simply the beginning. Insurance companies can lose or misplace claims, or never receive them at all. Therapists who don’t conduct regular audits on the state of their claims stand to lose significant amounts of money.

In the new economy, it’s essential that physical therapists code correctly to ensure they’re reimbursed for their time, services and supplies. Every precaution must be taken to provide clear and concise documentation. The implementation of a correct medical billing EMR will greatly reduce the number of errors, mistakes and denials for the financial health of any clinic.

Medical Billing and Coding – In-House or Outsourced?

Medical Billing and Coding – In-House or Outsourced?

In-house or outsourced medical billing and coding have their own advantages and disadvantages depending on the size and the needs of the physical therapy practice.

Nitin Chhoda elaborates the differences between these two methods, and how to maximize the billing and coding process for your business.

medical billing and codingMedical billing and coding are one of the most important tasks for practice owners to consider.

However, many are unsure whether to maintain a billing and coding department on-site or outsource the entire operation to a specialty firm.

In-House or Outsourced?

Both methods have their own set of advantages, but many therapists are finding they have the same set of tools available in their EMR as those offered by medical and billing companies.

Therapists have always had the option of outsourcing their medical billing and coding tasks, but it’s a major expense that may not be necessary with the implementation of an EMR. Physical therapy documentation software allows clinicians to submit bills electronically themselves, but they may still want to consider hiring a professional coder to work with the EMR.

Outsourcing Options and Benefits

Outsourcing medical billing and coding needs provide practices with a one-stop solution that takes the reimbursement process out of the office and places it in the hands of companies that employ trained coders who handle all the submissions and details. Such firms can verify insurance information and authorizations, reconcile accounts, and provide code checking and analysis services.

medical billing and coding optionsThe same firms can conduct audits to help clinics operate more efficiently and provide training for staff on medical billing and coding-related issues.

They eliminate the need for purchasing and establishing hardware and software infrastructure.

Outsourcing also negates the need to hire a professional coder and the associated expenses of a salary, insurance and benefits.

Coding and billing firms are HIPAA compliant and feature a rapid turnaround time for reimbursements.

They reduce the work associated with billing, providing therapists with more time to see clients. For some clinics, it’s an ideal situation. For smaller practices, it may be an added expense that the clinician simply can’t afford.

In-House EMR Advantages

Therapists using an EMR can send reimbursement claims individually or via batch filing. Therapists must implement an EMR by 2014 and EMRs contain their own medical billing and coding abilities.

It just makes sense to utilize the technology to handle a task that affects the financial stability and security of a practice. Since therapists must implement an EMR anyway, there’s no good financial reason to spend additional funds contracting with an outside firm.

An EMR provides therapists with all the services offered by a medical billing and coding firm, along with updated ICD-10 coding changes. Electronic submissions allow therapists to collect their fees quicker and they can be automatically deposited in the clinic’s account. EMRs are HIPAA compliant for security and safety, and enables users to conduct audits on the state of the practice.

EMRs offer the ability to verify client insurance information and eligibility, collect one-time and recurring payments from patients, and send balance reminders to clients in the form of email, text and voice messages.Clinicians can conduct medical billing and coding tasks themselves, or hire a certified professional versed in the intricacies of the EMR, new codes and EMR documentation systems.

Balance Cost and Convenience

In the final examination, all therapists must balance cost and convenience. Outsourcing to a medical billing and coding firm eliminates the need for an on-site coder and facilitates a quick turnaround on reimbursements, but the cost may be prohibitive.

EMRs are designed with the ability to manage patient accounts, submit claims electronically, and collect from patients online. Therapists must implement an EMR by 2014 and many are discovering that they don’t need to outsource medical billing and coding when they can accomplish the same tasks with their EMR.