Did you know that hospitals and other healthcare practices in the U.S. tend to lose approximately $125 billion every year due to poor billing and coding practices? Also were you aware that more than 60% of the medical bills submitted to the insurance companies contain errors? Well, these are stark reminders for healthcare practices that it is time for them to focus on billing and coding.

Here are a few basic rules that healthcare practices should follow to eliminate errors in their billing and coding practices:

1. Only Code things that are Documented

The first and foremost rule in medical coding is to go through the medical record and code only for things that are documented. Due to various constraints, physicians and nurses quite often fail to pen down everything that they do in the record, which is a malpractice. As per the law, if it is not in the record, it wasn’t done. Hence it is essential for them to document the medical record with exact descriptions of all tests and services precisely as performed. They should also make sure that the codes mentioned in the medical claim are in-line with the documentation present in the medical record.

2. Report Codes in Proper Order

Once you are done with coding diagnosis and procedures, the next step is to make sure that you are reporting it in the right order. Make sure that the very first code that is reported is always for the specific reason for which the patients visited the doctor.

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3. Stay up-to-date on Coding Changes

The accuracy of claims depends upon multiple factors. Being in-line with annual coding changes, adhering to standard coding guidelines and keeping detailed patient records are reliable ways to avoid mistakes in medical claims.

It is also be beneficial for medical practitioners to develop proper compliance system that can avert the violation of medical coding requirements.

4. Follow NCCI and MUE guidelines

Make sure that that you always use National Correct Coding Initiative (NCCI) and Medically Unlikely Edits (MUEs) guidelines to report unit of service. This is because abiding by these guidelines will prevent billing multiple services or procedures that should not be claimed together, as one service or procedure covers the other, or because it is medically implausible to be performed simultaneously on the same patient.

5. Use Appropriate Modifiers

Modifiers are the means by which the reporting physician can specify that a service or procedure that was performed has been altered by some particular condition, but there has been no change in its definition or code.

Just like its definition the use of modifiers is also very complicated. And any mistakes in the usage of these complicated codes can result in lost revenue and possible audits. Hence be very careful while using modifiers and reduce the risk of lost revenue and improve audit compliance.

Adhering to the above rules can be a tedious and irksome task for most healthcare providers, given that these tasks are not core to their business. However, much of these hassles can be overcome by outsourcing medical billing and coding service to a reliable third party service provider like us. Leveraging our extensive experience in the industry, we provide end-to-end medical billing and coding solutions that will help your practice maximize profits.


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