10 Medical Billing Errors Costing Practices $50K+/Year

Medical Billing Advocates of America estimates 80% of medical bills contain errors, most of which silently reduce practice revenue. For a 3-provider practice, this commonly translates to $50,000+ in annual leakage.

Here are the 10 most common errors and the workflow to catch each one.

The 10

1. Missing modifiers (25, 59, 95): most common cause of bundling denials
2. Incorrect place-of-service codes: especially telehealth (POS 02 vs. 10)
3. Underbilled E/M levels: 99213 billed when documentation supports 99214. Coding must always match documentation; consult your certified coder or compliance officer.
4. Missing co-surgeon / assistant modifiers (62, 80, 82)
5. Failure to bill add-on codes when primary code is present
6. Eligibility-lapsed claims: submitted without re-verification
7. Authorization not obtained before service
8. Timely filing missed: claims submitted past payer window (often 90-180 days)
9. Incorrect NDC units on injectable drugs
10. Missing referrals for HMO patients

The Catch-Net Workflow

Q&A

Q: Should I outsource billing entirely? A: Some practices benefit from full outsourcing; others prefer to keep coding in-house and outsource only AR follow-up. Both are viable. See our Medical Coding & Billing service.

Q: How much revenue can we expect to recover? A: A structured catch-net workflow helps practices recover billings that would otherwise be written off; the amount recovered varies by practice.

Q: Do you handle credentialing too? A: Yes, credentialing and re-credentialing are part of our practice operations support.

Related

• Medical Coding & Billing
• Insurance Verification
• Prior Authorizations

This article is general information, not legal advice. Consult qualified healthcare counsel for your practice's obligations.