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eClaim Solution > RCM  > The Top 7 Medical Billing Issues
physician checking medical bills

The Top 7 Medical Billing Issues

Medical billing is an essential aspect of any physical therapy practice. Even when it’s a top priority, complications might impede cash flow, lead to refused claims, and cause financial troubles. The idea is to utilize medical billing management software that reduces the likelihood of billing issues. One of them being medical enrollment.

Medical institutions worldwide are experiencing a significant dilemma regarding medical billing services. Nearly every healthcare system has problems with issuing, tracking and paying off bills. Some difficulties stem from the patients, while others stem from the medical institutions. They require the most effective, and sophisticated medical billing management and payment systems.

Top 7 Medical Billing Concerns and their Solutions

Here are seven frequent medical billing systems issues and their respective resolutions!

1. Insufficient Information

Omitting essential information on a claim, such as the patient’s date of birth or injury, is a typical error. A blank field may result in an insurance company denial, even if there is no erroneous information and the patient is covered.

Before submitting your claims, you must verify that they contain no missing information or blank fields. It is your best chance to identify omissions before they result in a time-consuming denial and resubmission process.

2. Erroneous Patient Identification Information

Even slight problems might lead to errors when inputting patient information into your medical billing system. Every clinician knows that insurance companies routinely refuse claims for trivial mistakes, such as misspelling a patient’s name or changing their birth date. A medical billing service provider will ensure that all data is accurate, so there’s no chance of claim denials.

There are two ways to address this matter. The first step is to double-check each entry to guarantee its accuracy. The second step is to select medical billing management software that automatically populates the patient’s bill with their validated data.

Suppose you have patients enter their information and confirm it with you before their first initial evaluation visit. In such a scenario, it is unlikely that this error will result in a payment delay.

3. Incorrect Coding

One of the most frequent and time-consuming errors made by physical therapy firms is incorrect medical claims coding. Some of the various reasons why claims are wrongly coded:

  • Use of obsolete coding manuals
  • Charges that should be controlled under the same procedure code are handled separately
  • Overcharging and undercharging
  • Incompatible codes
  • Absent codes

The solution is to select a system for medical practice management that incorporates coding automation that is updated to reflect the most current coding requirements. Using software with the flexibility to include just codes particular to each medical insurance provider can minimize billing time and eliminate the possibility of error.

4. Duplicate Billing

Sometimes, one staff member will prepare a patient’s bill, and another will prepare the same one without recognizing that it has already been designed. In such a scenario, a double bill would result in double expenses for the patient and an angry client. With manual billing and spreadsheet administration, duplicate errors are common.

The solution is automation, which can automatically generate a bill and detect duplication if someone tries to create a second bill for similar services and treatments. Proper staff training for medical billing services can also help reduce this problem.

5. Insufficient Documentation

Every insurer requires documents to process claims payments. Without it, they may deny your claim and return it to you, in which case you will need to supply the required documents and resubmit your claim.

Ideally, your medical billing management software should make it simple to provide supporting evidence alongside a claim.

6. Expenses Not Included

Insurance coverage for a patient may vary for various reasons, including a job change. Additionally, there may be limits on the number of paid physical therapy visits or treatments, beyond which the patient would be responsible for payment.

Incorrectly charging an insurance company might result in costly delays and make it more challenging to recover from the patient or their new carrier. It is necessary to verify the patient’s insurance coverage at each visit. You must verify the patient’s insurance coverage while confirming that their benefits have not run out.

7. Absence of Recommendation or Authorization

Before getting physical therapy, several medical plans require patients to obtain a recommendation from their primary care physician or permission from patient services.

Again, you will need to confirm with the patient and ensure that your team is aware of the limitations and requirements of the carrier. Before submitting a claim, you can work with the patient to obtain the referral if it is absent.


Proper medical billing systems demand attention to detail. Addressing these errors helps ensure that your billing is accurate and that your patients are adequately cared for. Simple-to-use medical billing management software can assist automate these operations and alleviate the billing burden.

In conclusion, the medical field desperately needs creative and effective billing solutions. Since so much is still falling through the gaps, no one can afford to wait any longer.

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