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How To Avoid Overbilling And Misbilling With Professional Medical Billing?

Professional Medical Billing


Medical billing can be difficult, complicated, and tedious. What else can you expect from a task where you must keep track of so many rules that are constantly changing? There are many chances that you will make mistakes. To make matters worse, many people may not be aware that they are making mistakes. Medcare MSO Medical billing services can monitor, track, and collect your payments for medical services. No matter if your billing errors are intentional or accidental, you must face the consequences. It is important to be familiar with the do’s and don’ts of billing before they can eat into your bottom line. Let’s now look at the most common billing errors, misbilling, and overbilling. We will also discuss ways to avoid them.

Professional Medical Billing

Professional Medical Billing
How To Avoid Overbilling And Misbilling With Professional Medical Billing?


Overbilling is a tactic to secretly receive higher payments. There are three possible ways this can happen:

Upcoding: This refers to the practice of entering an incorrect billing code for a service that is more expensive than it is.

Overcharging: This refers to the practice of charging extra units for services or adding codes for services not rendered.

Utilization abuse: The practice of scheduling unnecessary visits and providing unsuitable services.

How to Avoid It

Overbilling, as mentioned, is intentional. The only way to stop it is to implement appropriate monitoring mechanisms. This ensures that no deviation is made in billing or delivering medically required services specific to each patient’s treatment plan.


Misbilling can be caused by input mistakes, timing issues, or manual errors.

These usually occur when your practice fails to meet the following:

  • Clean claims
  • Coding at the highest possible level of specificity
  • Correct billable codes

Only code things that can be documented

Medical coding begins with the first rule: only code for what is documented. A lot of physicians and nurses fail to record everything they do in the medical record due to various constraints. This is malpractice. It is a violation of the law to not have it on record. It is crucial that they document the medical records with precise descriptions of all services and tests. They must also ensure that the codes in the medical claim match the documentation in the medical record.

How to Avoid It

The best way to avoid misbilling is to streamline your billing workflow by following these steps:

  1. Perform an internal billing audit promptly

Regularly conduct internal audits and track all processes, from documentation to coding to claims creation. Examine every claim denied and determine the root cause. Then, take the necessary steps to correct the problem.

  1. Services for leverage billing

Third-party billing services can help you with your billing problems, including misbilling. Make them an integral part of your practice.

  1. Level set your team

Engage and interact with your team members on a regular basis to ensure that everyone is on the same page.

  1. Examine every single denied claim

Recent studies show that only 40% of healthcare providers appeal denied claims. This is unacceptable. Many times, claims are denied because of errors made by payers. It is a good idea to examine the reasons for the denial of every claim.

Overbilling and misbilling are not small or inconsequential errors. These errors are more common than we thought and are becoming more frequent. These mistakes are not something to ignore. Instead of looking the other way, take responsibility and make sure they don’t get out of control.

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