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Top 10 Outpatient Billing Errors, and How to Fix Them

Top 10 Outpatient Billing Errors, and How to Fix Them

BALTIMORE—"With increased referrals to the outpatient department, hospitals must monitor outpatient revenues to remain financially competitive in today's market," Karen O. Marlo, MPP, said at the Association of Community Cancer Centers (ACCC) 33rd Annual Meeting.

Ms. Marlo stressed that hospital outpatient departments need to be aware of billing pitfalls and learn how to avoid or correct them to minimize denials and delays in payments.

Here are Ms. Marlo's top 10 hospital outpatient billing errors, along with the solutions:

# 10 Right Patient, Wrong Insurance Card

Denial reason: Expenses incurred prior to coverage or after coverage terminated; noncovered services.

Solution: Verify (re-verify if necessary) patient's eligibility prior to rendering service. Document effective date of coverage, service allowed under patient's plan, and level of benefits (should co-payment be collected?).

# 9 And Doctor, You Are . . . ?

Denial reason: Provider number not valid or not included.

Solution: Effective May 23, 2007, all providers must include the National Provider Identifier (NPI) number on the uniform bill form (UB-04) (FL 56).

# 8 He Came to the Hospital for That?


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