8 Most Common Medical Billing and Coding Errors

August 17, 2022
 Mins Read

Did you know that about 50 percent of all Medicare claims are somewhat inaccurate? Medical billing and coding errors are common and consume a lot of time and energy to resolve. Your untrained medical billing and coding staff costs you money if you don't successfully navigate these issues. Unfortunately, the smallest error causes significant damage to the claim and payment processes. These frequent errors reduce transparency and jeopardize your relationships with the patients. Hence, you should focus on finding better ways to deal with these issues to improve operations and customer relations.

Here are Most Common Medical Billing & Coding Errors

1. Inaccurate Procedure Codes

A single wrong tap on the keyboard inputs an incorrect procedure that stores a flawed code in the medical system. This inaccurate code corresponds to faulty information in the form that damages the integrity of your billing system. Hospitals collect a huge claims pile due to the staff's inefficiency to adhere to rules. To avoid these issues, educate your staff by providing enhanced coding training and ensure strict process adherence. Being aware of these common coding errors reduces the chances of repeating such issues.

2. Mishandled Payments

You either lose money or damage credibility when you don't handle payments well. Additionally, you can also deny claims when you don't handle payments well. Claims denial usually occurs because of underpayment or overpayment issues. You need to fix underpaid claims immediately because you could potentially lose revenue because of it. For both sides, any interest payments need proper processing by strictly enforcing the right procedure. You need to find a process to notify the defaulters immediately.

3. Missing Information

Did you know that 3 out of all 10 tests are lost and reordered? Missing information is a real issue plaguing several medical organizations. Among several issues it causes, omitting important information leads to claims denial. Fortunately, you can easily rectify the issue and prevent it from happening in the future. Not checking for mismatches increases your chances of receiving a denied claim. Billing departments usually overlook mismatches because they are extremely busy. However, you need to find a way to address these issues. Being cautious with fields before applying for a claim helps you prevent major medical billing and coding errors. A minute look at the claims form for insignificant details like name, address, gender, insurance information, and birth dates also helps you avoid issues. Furthermore, ensure no incorrect data is entered in the system to process claims faster.

4. Unbundling Errors

Used in medical processes, unbundling reduces a single procedure into different smaller procedures. Some organizations bill these smaller processes separately to deceive their patients into paying higher charges. This act is extremely unethical and causes troubles during audits. When you have a comprehensive code for the entire procedure, you should process the complete process at the same time. You can easily remedy the situation by making your medical coders aware of this error.

5. Upcoding Errors

These errors occur when you bill your clients for more complex and costly procedures than they opted for. Executives make these errors when they enter treatment and diagnosis codes incorrectly. Often doctors can charge for a 45-minute consultation when they meet the patient for only 15 minutes. Doing such a thing can make the medical professional liable to legal action. A medical professional was charged $400,000 in fine due to upcoding issues.

6. Duplicate Billing

You can face these issues when you bill the same procedure multiple times. Not only does it increase medical costs, but it also results in you re-submitting a claim instead of sending a follow-up claim. You can usually divide these errors into two categories: exact duplicates and suspect duplicates. Both these claims are handled differently by the claims departments. While exact duplicates are denied right away, suspect duplicates are put on hold by concerned authorities. However, both these errors cost your coding and billing team significant time and effort to rectify these errors.

7. Outdated References

Keeping your staff updated with the latest codes is critical to maintaining the sanctity of your billing system. Different code references need regular upgrading to stay relevant. If you don't replace outdated references with new ones, you can lose revenue because of it. Using outdated codes increases the work hours needed to fix these issues. This delay can make you lose eligibility to participate in different pay-for-performance programs that offer several financial incentives. Being up-to-date with the working terminologies helps your patients and staff be eligible for many important incentives.

8. Digit Transposing

An accidental switch between two numbers while typing fast can disrupt the claims and payment processing in the medical coding systems. This error occurs while entering numerical data like birth date or ID numbers. You can easily avoid these issues by asking your staff to double-check the entered numbers. Ensuring your coding software provides useful prompts to check the information before processing claims also improves your chances of reducing such errors.


Each medical error costs an average of $13,000. Imagine the devastating compounding effects of this huge sum for multiple errors! Handle these issues with caution and proactiveness today! Encouraging good training and efficient processing helps in the longer run. We hope you understood how to solve common medical billing and coding errors.

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