Mitchell: Workers’ Comp Billing Errors Could Be Costing Payors

April 23, 2018

Inappropriate coding and unbundling were two of the most common billing issues Mitchell found during their medical billing audit. The analysis was presented in Mitchell’s Q1 2018 Industry Trends Report.

The author of the first in a three part series on auditing workers’ comp medical bills for errors and abuses, Michael Parker, senior director of Product Management for Mitchell’s SmartPrice Solutions, said the issue is a market wide problem. Out of the hundreds of thousands of bills audited, Mitchell found 35 percent contained some type of billing error.

The most common issues related to billing errors that Mitchell found included:

  • Edits
  • CCI issues (inappropriate coding)
  • Unbundling (billing for multiple procedures covered by one comprehensive code)
  • MUE errors (medically unlikely edits)
  • Other

According to Parker, medical billing errors frequently happen when billing departments translate services rendered to billing codes.

Simple errors include data entry mistakes, unbundling services, upcoding and inaccurate bill types. Complex errors, on the other hand, include split billing, which occurs when surgery codes are separated from medical supplies. This type of billing could be the result of a mistake or an overall abuse by the provider.

To avoid billing errors, Parker recommended payors utilize an automated auditing platform that can sort through bills and identify questionable billing for a detailed nurse review.

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