$68 Billion in Medical Billing Errors Creates High-Risk Situation for Providers

medical billing errors

When it comes to medical billing errors, the numbers are staggering: as many as 80% of all medical claims submitted to insurance carriers contain errors costing approximately $68 billion. Additionally, the incorrect coding of about 55% of evaluation and management (E/M) claims has resulted in roughly $6.7 billion worth of erroneous Medicare payments.  

Physicians who are hoping to dodge the consequences of such errors – namely, lost revenue and other grim penalties – have begun to require more training for their staff, and seeking out employees who have obtained a specialized training and certification program.

A Sharper Eye

Because of the multitude of medical billing errors, there are more watchdog agencies enforcing the rules than ever before – and more penalties, too. This has created a high-risk situation for providers, 17,000 of whom have lost their license to bill Medicare due to tougher screening measures.

Even when a staff member handles claims and coding, the physician is ultimately responsible for every claim that’s billed under their unique provider number – and it’s literally the physician’s signature on those claims that verifies its accuracy and legitimacy. So if there’s a mistake, the doctor’s name is very much on the line.

All of this ramped-up scrutiny has prompted many providers to require their staff to become certified in medical billing, and any staff member who knowingly submits a fraudulent claim for payment can be held liable for that error.

Keeping the Physician’s Focus on Patient Care

Most physicians are more concerned with providing an excellent patient care experience than they are overseeing the medical billing process. For that reason, they tend to have a less thorough understanding of medical claims management than someone who’s been specifically trained in that area.

Today’s doctors prioritize the hiring of a billing and coding staff who will stay up-to-date on Medicare and other third party guidelines – but now, they’re looking for more than just experience. They’re looking for official certification.

Avoid Medical Billing Errors – Contact MBM Today

If you want to ensure that your medical billing and coding is done properly, and you want to avoid costly errors that could jeopardize your entire practice, Medical Business Management is ready to help. We specialize in anesthesia and pain management billing, and we can help physicians stay focused on their patients instead of worrying about possible errors on insurance claims.  

Interested in learning more? Take a look at some of the services we can offer your clinic.