Insurance Billing Mistakes That Are Costing You Money (And How We Catch Them)

Medical billing errors are more than just clerical mistakes—they’re revenue leaks that can quietly cost your practice tens or even hundreds of thousands of dollars every year. From claim denials to underpayments, small issues can snowball into bigger financial problems when left unchecked.

The good news? Most billing mistakes are preventable. Even better: with the right systems, audits, and workflows in place, you can identify and correct them before they impact your bottom line.

In this article, we’ll explore the most common insurance billing mistakes we see in healthcare practices—and how we help practices catch (and fix) them before it’s too late.

1. Incorrect or Missing Patient Information

This is one of the most common—and most easily avoided—billing mistakes.

The problem: Claims are denied or delayed because of:

• Misspelled patient names

• Wrong date of birth

• Inaccurate insurance ID numbers

• Old or inactive insurance plans

Why it matters: These small data errors can trigger automatic rejections by payers, leading to lost time, resubmissions, and cash flow disruption.

How we catch it: We implement front-end eligibility checks and verify insurance information before each visit. Our systems automatically flag mismatches and prompt your staff for corrections before claims are submitted.

2. Improper Use of CPT or ICD-10 Codes

Coding errors are one of the most frequent reasons for claim denials—and they’re also a red flag for audits.

The problem:

• Using outdated or invalid codes

• Mismatching diagnosis and procedure codes

• Undercoding or overcoding

• Forgetting modifiers

Why it matters: Incorrect codes can result in:

• Claim denials or underpayments

• Reimbursement delays

• Compliance risks and audit triggers

How we catch it: Our certified coders perform pre-submission reviews to ensure coding accuracy and alignment with payer rules. We also stay current with annual code updates and payer-specific guidelines.

3. Missing or Incomplete Documentation

Even if your coding is correct, if the documentation doesn’t support it, the claim is at risk.

The problem:

• Missing progress notes

• Lack of medical necessity documentation

• No proof of time-based services (e.g., therapy sessions)

Why it matters: Payers may deny claims or request recoupment during audits if documentation doesn’t support billed services.

How we catch it: We perform documentation audits and work closely with providers to ensure SOAP notes and encounter forms align with services billed. When needed, we flag gaps and recommend updates before claim submission.

4. Failure to Verify Eligibility and Authorization

Assuming a patient’s insurance is active—or failing to obtain authorization—can lead to outright denial.

The problem:

• Skipping eligibility checks

• Missing prior authorizations

• Not confirming out-of-network limitations

Why it matters: You could provide services you won’t get paid for, or be forced to write off large amounts due to avoidable technical denials.

How we catch it: We use real-time insurance verification tools and set up automated workflows to request and track prior authorizations. We also maintain payer-specific authorization rules for different services.

5. Late Claim Submissions

Most payers have strict filing deadlines—often 90 to 180 days from the date of service.

The problem:

• Delayed claim submission

• Missed resubmission windows

• Lack of follow-up on aging reports

Why it matters: Once the window closes, the claim is no longer payable—resulting in 100% lost revenue for that service.

How we catch it: Our billing process includes daily claim submission and built-in alerts for aging claims. We monitor pending claims and rejections proactively to ensure no claim is left behind.

6. Unworked Denials

Many practices submit claims and move on—but fail to follow up when a claim is denied or underpaid.

The problem:

• Denials not appealed

• Partial payments not questioned

• No tracking of common denial trends

Why it matters: Denials are often recoverable, but only if someone takes the time to investigate and follow up. If ignored, that money is permanently lost.

How we catch it: We have a dedicated denial management team that reviews every rejected claim, identifies the root cause, and resubmits or appeals when appropriate. We also provide monthly reports showing patterns and recommended fixes.

7. Incorrect NPI or Tax ID Linkages

Claims are denied when NPIs and tax IDs don’t align with what payers have on file.

The problem:

• Providers not properly linked to the group contract

• New locations not enrolled correctly

• Outdated enrollment details on file with payers

Why it matters: This often results in preventable denials that slow down cash flow—and can also indicate broader credentialing issues.

How we catch it: Our team cross-checks billing info with your payer enrollment data and ensures all NPIs, tax IDs, and addresses are linked and up to date. If needed, we help correct and re-enroll providers with the appropriate payers.

8. Incorrect Patient Balances or Statements

Billing patients incorrectly or failing to follow up on balances can damage your reputation and lead to compliance issues.

The problem:

• Overbilling or double billing patients

• Not applying insurance payments correctly

• Failing to send timely statements

Why it matters: Patient trust erodes, and you're more likely to face complaints, refund requests, or lost business.

How we catch it: We use automated patient billing tools that reconcile EOBs with real-time balances. Our system ensures accurate statements, clear breakdowns, and timely follow-ups on unpaid balances.

The Cumulative Cost of These Mistakes

While each of these mistakes might seem minor on its own, they add up quickly. Over time, a practice that isn’t actively managing its billing process can lose 5%–15% of total revenue annually—sometimes more.

For a practice billing $1 million a year, that’s $50,000 to $150,000 in preventable losses.

How We Help Fix It—Step by Step

When we take on a new client, we start with a comprehensive billing audit. This helps us:

• Identify patterns in denials and underpayments

• Evaluate current coding practices

• Review payer mix and credentialing status

• Improve front-end workflows (scheduling, verification, documentation)

From there, we set up:

• Clean claim submission processes

• Real-time denial tracking

• Monthly reporting with actionable insights

• Ongoing provider training and support

Our goal: stop revenue leaks before they start and ensure every dollar earned is a dollar collected.