Documentation and communication are fundamental in avoiding a malpractice claim.
Medical malpractice happens when a healthcare professional’s actions or inactions cause injury or death to a patient, and the error is the direct cause of the harm. Most people believe that all malpractice cases come from a severe surgical error. However, most medical malpractice claims come from simple mistakes, like billing errors, lack of consent from patients, poor documentation, and more. Here’s how to avoid these medical malpractice errors.
Impact of Medical Billing Errors on Malpractice Claims
Medical malpractice and billing errors are interconnected in diverse healthcare practices, including ABA therapy practices. In most cases, patients expect malpractice to be related to a surgical error, but it can also be related to billing errors. For therapy practice, malpractice can include misdiagnosis, breach of confidentiality, and failure to inform patients of the risk of treatment. Most practices, especially therapy ones, opt for outsourced ABA billing to avoid mistakes like this.
Medical billing errors can lead to increased medical malpractice claims at healthcare practices. Billing errors lead to negligence and poor practice management, so even if there is no clinical error, proper care won’t be administered, and patient experiences suffer.
Using the wrong medical codes for procedures can lead to significantly different billing amounts, fueling a malpractice claim. Duplicate billing can be even worse, as this can be interpreted as fraudulent activity, increasing the likelihood of legal action.
Poor documentation and missing patient information can also lead to malpractice claims. When it’s time to defend your medical care, poor documentation makes you susceptible to a malpractice lawsuit. Moreover, a therapist’s failure to adequately document a patient’s condition can lead to a malpractice claim.
When defending against a malpractice claim, billing errors can work against the healthcare practice, making it difficult to prove that the healthcare provider’s actions were appropriate. Billing errors lead to denied claims, denied payments from insurance companies, and increased stress for the medical team.
Tips To Avoid Medical Malpractice Claims
Professionals should focus on providing quality healthcare and follow best practices in documentation and patient care to avoid medical malpractice claims.
- Get Informed Consent:
It’s essential to receive informed consent whenever you provide medical care to a patient, whether surgical or therapy. This includes explaining the procedure’s elements before it occurs and comprehensively advising the patient of the risks. In an ABA practice, for instance, informing the patient of any situation where their medical record may be shared with third parties is essential to avoid a lawsuit.
- Review Practices:
It’s essential to review clinical practices and check patient feedback regularly. For example, conducting regular team meetings in an ABA therapy clinic to discuss patient progress, challenges, and feedback helps therapists provide effective treatments and interventions. Additionally, staying updated with the current malpractice laws in your state and ensuring your medical and administrative team is constantly trained with the latest practices is essential.
- Proper Documentation:
Documentation and communication are fundamental in avoiding a malpractice claim. Inadequate documentation leaves you more vulnerable to a malpractice lawsuit. Ensuring writing is legible is a tip many healthcare professionals could benefit from heeding, and documentation is essential for therapy practices like ABA centers. That’s because ABA therapy requires detailed and specific interventions tailored to each patient’s needs and might require multiple therapists working with the same individual. Record all the findings, instructions, advice, decisions, doctors, and other people involved in the treatment.
- Manage Patients Properly:
Follow up with your patients after treatment or examinations. This will allow you to cover all the necessary bases of the patient’s situation. Properly manage your patient’s expectations and focus on open communication with patients. To manage a patient’s expectations, it’s essential to be transparent from the initial consultation and organize regular follow-ups. For example, an ABA therapist can explain to the patient that progress might be gradual and results may vary. They would also periodically discuss the patient’s progress and tweak the therapy plan as needed. It’s also essential to provide written information that helps patients understand their treatment better and set realistic timelines for short- and long-term care.
Strategies for Mitigating Billing Errors
Billing errors are a significant issue that can sometimes lead to unintended consequences. A common billing error is coding mistakes, like misinterpreting the type of therapy session or the time spent on a specific treatment. Duplicate billing is another error, when the service is billed more than once, often because of system glitches or clerical errors.
Unclear or missing documentation is another frequent source of billing errors, which makes it difficult for the billing department to accurately understand what treatment was provided, leading to a claim denial. Billing errors contribute to complex billing systems, insufficient training, staff turnover, or even rushed work in busy environments.
For instance, in an ABA therapy clinic, if a therapist provides a certain type of behavioral intervention, they must thoroughly document all the specifics, like what was discussed, any progress made, and the time spent. Failing to note these details and provide a generic billing code can cause the insurance company to deny the claim.
Tools like CureMD and Kareo come with tools to streamline billing operations for a healthcare practice, while others like Theralytics and AlohaABA are designed specifically for ABA practices. To avoid errors related to coding, practices can also use software like Find-A-Code and AAPC Coder. Regular audits are also essential to identify errors in the billing process. Staff training is necessary to reduce billing errors, especially regarding new coding updates, insurance regulations, and best practices.
Most healthcare providers use centralized software to input patient information, reducing the chances of errors and tracking the treatment plan throughout the patient’s time with the clinic. This is particularly important because staying updated with the latest changes in insurance policies, and billing regulations can help remain compliant. Some insurance services also include reasons for rejection, such as incorrect patient information, mismatched coding, lack of authorization, or non-covered services. To avoid claim denials, thoroughly review your billing claims for errors in patient information, procedure codes, and diagnosis codes.
Claim denials can occur at any stage in the billing process. For instance, if you use the wrong code, the claim can be returned before it is even processed. Without authorization, it can be rejected during the review process. If the claim is permanently denied, perhaps because of non-covered services, the patient would have to pay for the treatment out of their pocket. However, if the claim is denied because of simple errors like wrong coding or missing documentation, it simply means the patient’s care would be delayed.
Avoiding the Consequences of Incorrect Medical Billing
To truly protect your practice and your patients, avoiding medical malpractice insurance claims is crucial. This starts with being vigilant about billing errors. For instance, misinterpreting codes, submitting duplicate charges, or failing to provide sufficient documentation can lead to claim denials or malpractice lawsuits. These errors can also cost your practice money and risk your credibility and trust with patients and insurers. Regularly train your staff and conduct audits to catch patient records or coding inconsistencies. Still, insurance systems can be complex, and a high volume of cases can challenge ABA billing. This is where outsourcing billing to third-party experts can be an invaluable strategy. By partnering with specialists who are well-versed in ABA coding, insurance requirements, and best practices, you can reduce the burden on your team.
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