Medical abuse, frauds, unbundling, upcoding, imprisonments. We all are familiar with these words. Because such issues have been in the limelight for the last few years. Do you know the healthcare industry has become one of the major victims of healthcare frauds? Therefore eliminating medical abuse has become a top priority for the federal government. In addition to the compliance issues, the constant financial loss has become another major headache for medical care providers. Because they are losing millions of dollars annually due to certain reasons. Which negatively impacts their financial well-being and overall sustainability.
So, it has become very challenging for medical practitioners to survive in this highly competitive healthcare market. And stay ahead of the competitors. Imagine how it can be frustrating for physicians to not collect their hard-earned revenue for the medical services provided. Have you ever thought about what are the major reasons that can cause financial as well as compliance issues? You might be surprised to know this fact. That “ errors in medical coding” can land healthcare providers in a tough economic situation and legal issues.
Sometimes you may neglect the coding errors as they may seem minor. But you must understand the fact that seemingly minor mistakes in coding can lead to claim denials and declining reimbursement. Therefore, accurate medical coding has become one of the major concerns of medical practitioners. Regardless of how qualified the physician is, practices can struggle if medical billing services are not on the right track.
What Are the Most Common Coding Errors?
Coding errors occur when medical coders show negligence in translating the patients’ diagnosis, treatments, medical equipment, and services into codes. However, here are the following coding errors that can cost your healthcare practice.
When done intentionally, upcoding is totally unethical and illegal. It occurs when medical coders file the medical claims with codes for the more expensive healthcare services than actually rendered. Sometimes, healthcare providers are intentionally involved in this malpractice to generate maximum revenue. This coding mistake can cost you higher. You can lose compensations from the insurance companies either private or government entities permanently.
These coding errors are deliberate and occur when patients are billed for the less expensive medical services that were performed. This coding malpractice is also considered fraudulent activity. That can be performed in order to avoid audits. But it is a total misconception that under coding can save you from audits.
In this illegal activity, medical coders use multiple codes to describe a medical procedure. when there’s a single code for the whole group of procedures. Most of the time, healthcare providers are involved in this billing fraud to gain higher reimbursements from insurance agencies.
Modifiers are used to describe the additional information about the medical treatments or procedures. When CPT codes fail to describe it properly. So using the incorrect modifiers can also lead to claim denials.
Risks Associated With the Coding Errors
All the above mentioned or other coding errors can affect your medical practice in the following ways:
1. Significantly Impact Reimbursements
Significant revenue loss is the major obstacle in growing the healthcare business. However, coding errors are the top reasons that lead to claim denials. Because healthcare insurance companies get the information about a particular injury, treatments, and medical services, patients receive these codes. If the codes fail to describe all this information including the diagnostic testing, and chargeable supplies that are used, appropriately. Then payers reject the medical claims without processing.
Which results in denied, partial, or delayed payments. That negatively impacts your cash flow. It has been estimated that approximately 65% of denials are never corrected and resubmitted to collect maximum revenues. A pile of denied claims eventually increases the medical accounts receivables and physicians lose the reimbursements forever. As for reworking, the denied medical claims are a time-consuming, complicated and costly process. This increases the administrative and financial burden of the healthcare providers.
2. Repeated Mistakes Lead To Medical Fraud
As we have already discussed that some coding errors i.e. under coding, upcoding etc, are considered as medical frauds. Whether intentional or careless, repeated submissions of claims with coding errors or inappropriate codes can lead to a lawsuit. Such as heavy fines, federal penalties, cancellation of licenses, and imprisonments.
The healthcare sector of the United States has witnessed a surge in billing frauds. For instance, over 300 healthcare providers including licensed medical professionals were charged in 202 for their involvement in fraud, and abuse schemes. That results in more than $6 billion in false claims.
3. Negatively Impact Patient Care
Every medical practitioner strives to improve the patients’ lives by providing them with standard medical aid. Because patient care is the primary objective of their healthcare business. However, incorrect medical coding can hold you back from delivering quality medical care. Aside from impacting the reimbursement, inaccurate coding can also directly harm the patient’s treatment.
Even a slight error in the medical coding during the authorization process can indicate a wildly different diagnosis. This cannot only lead to the claim denials but also negatively impact your patient’s experience. If your patients will not be satisfied with your care services, they might not visit your medical facility again. As a result, you will lose the opportunities for revenue generations. And it impacts your business relations and reputation in the healthcare market. You should always keep in mind that customers can make or destroy your business.
Tips To Avoid Coding Errors
- If you are losing payments due to coding errors and don’t know what to do. Then you must read the following tips carefully, which can help you to mitigate the coding errors.
- Make sure that you have complete and up-to-date patients’ records.
- Capture the accurate patients’ demographic as well as insurance information.
- Stop using manual methods to collect, process, and share healthcare data. You should use advanced billing and coding software.
- Conduct regular training sessions for the billing and coding staff. So they can stay informed about the new, deleted, or modified medical codes.
- Always use the updated coding books to choose the right CPT, ICD-10, and HCPCS codes.
- In order to keep your business running smoothly, physicians must acquire the assistance of the certified billers and coders. Because the adaptation to ICD-10 and continuous changes in the medical coding has made this process extremely complicated. So, gone are the days. When healthcare providers were used to putting the responsibility of coding to the existing staff with zero to little knowledge.
- The best way to prevent coding errors is outsourcing medical billing services to a trusted third party. outsourced billing companies hold AAPC-certified coders, having a complete understanding of the latest coding classifications. They ensure the use of precise diagnostic and procedural medical codes. Eventually, healthcare providers can get rid of all compliance and financial issues.
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