Medical coding and medical billing together have a big impact on the efficiency of revenue management process. Medical coding is the process of assigning codes to medical diagnosis and cares. Medical billing, on the other hand, is a part of the revenue cycle management process that includes providing the figurative amounts of expenses to the payer. The two stand apart in many ways. But at the same time, the two together decide how effective your revenue cycle process is in keeping the cash flow ringing.
Understanding the connection between coding and billing will help healthcare providers overcome much of the challenges associated with revenue cycle management. This will help maximize reimbursements, without any delays. In this article we will discuss about the common mistakes in medical coding that lead to.
Medical coding is important because it helps to decide whether a medical claim will be accepted or rejected by payers. Accurate coding guarantees billing success. Any problems associated with coding, such as mismatched or inaccurate codes, severely affects reimbursements and in the process affects revenue cycle performance. This is why coders need to be very alert in discharging their duties.
Given below is a list of errors committed by coders that lead to issues like delays and denials:
This is a common error and has existed since the concept of coding came into existence. There are multiple factors that lead to such errors. One such reason is over reliance on manual intervention. Further, dependence on physicians, who are perpetually busy lead to lot of sloppy handwriting. This leads to misreading handwritings. Most documentation errors happen in emergency departments. There are number of instances wrong coding entry in such scenarios.
This is another common coding mistake that can lead to denial. It involves using separate codes for linked procedures instead of a single available code for the whole group of entire procedure. This is interpreted as an illegal act. Most payers view it as attempt to make more money by adding different procedures. This sort of error is mostly committed by newly inducted coders.
Upcoding is a frequently committed mistake in healthcare billing. The result can be denied payment. It involves keying in a code that is meant for a more complicated service than the one performed. Since usage of higher codes means demanding higher payments, it is interpreted as a wrongful way of making revenue.
There is yet another type of upcoding - to bill for a greater number of visits than it actually happened. Also, doctors may apply few modifier codes to tell that additional service were provided during a patient visit. One such example of upcoding is to use a modifier code to show additional services were provided when the services come under one standard code for the patient visit.
Undercoding happens when practices do not bill patients for all the services or treatment rendered. This is primarily done to help a patient avoid an expensive bill. In some hospitals, it is done to ensure emergency department do not have to go through audits. It primarily manifests itself in two forms - failing to report services performed at the encounter and not exactly reporting the level of service provided
The impact of under coding errors can be huge. On an average it costs the industry millions of dollars every year. Correct coding is interpreted as a violation because the statistics are used to compute future Medicare payments. Any type of under coding practice can bring a practice under the scanner. This can potentially invite audits and reviews. The other big disadvantage of under coding is that it impacts revenue inflow. It means you are not being rightly paid for the service you render to your patients. Further, correcting under-coded claims may end up in costly legal battles.
This is an error which happens when a patient is billed for a service more than one time. This can be for a procedure, testing or treatment. Duplicate bills can also happen when a bill is issued for an incorrect patient service or for services that never took place. Attempts to bill two insurance companies for the same treatment or an insurance company and the patient at one time is interpreted as duplicate billing service. Other examples include charging more than once for the same service by failing to check if they already billed for a procedure.
The impact of duplicate billing can be huge on an organization. It can lead to complete loss or delay in payments, loss in reputation, and an investigation. In the last year the most common for duplicate billing has costed $30 million in fines.
All CPT codes have limits to the complexities involved. Sometimes, a procedure may be more complex than the acceptable levels of complexities. It is in such cases that modifier 22 comes into play. It is used to tell the payer about additional procedural services performed because of necessity. The code tells how the physician had to go above the typical procedure to successfully complete a surgery.
Usage of modifier 22 sometimes tend to get incorrect. The reason being scenarios that qualify for its use are not quite common. Such incorrect usage is interpreted as misuse of coding. Any such misuse invites additional payer scrutiny. This leads to audits, and delay or denial of payment. Some common errors in using Modifier 22 include billing from a facility, because Modifier 22 is only a physician code; replacing an apt CPT code with Modifier 22; if it defies a simpler approach to the surgery and if the work is not separately reimbursable.
Much of these mistakes can be avoided if you partner with a third-party company specializing in medical coding. These companies provide you with experienced coders, a well-defined coding process and multi-level quality control mechanism to ensure there are no errors in billing and coding medical.
This article is brought to you by MedBilling Experts a renowned back-office support provider for healthcare services. We specialize in providing end-to-end revenue cycle management services to our clients. This primarily includes medical billing, medical claims processing and denial and medical coding. Our medical coding process is driven by dedicated specialists. They have vast experience in managing processed and working with physicians to ensure accurate documentation. If you are looking for clearing temporary backlogs or meeting long-term professional medical coding requirements services, get in touch with us to know more about our service.
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