Miscoding, or incorrect coding, is possible in any medical practice that does not provide continuing CPT code education to their medical coders. Recognizing the consequences of these coding mistakes is critical, and outsourcing medical coding to an expert service provider may be a prudent option.
Insufficient medical paperwork is one of the leading causes of medical coding mistakes. ICD-10 has resulted in implementing more detailed codes, and the CMS modifies regulations quarterly and annually. Incorrect medical coding will result in delayed payments, refused, or only partially reimbursed. If you accumulate a backlog of delayed payments, your medical practice will be burdened with lots of paperwork, stress, and lost money.
Common Medical Coding Errors
For a smooth refund, every detail of your claim must be correct. However, your staff may be performing some of the most prevalent medical coding errors, either purposefully or accidentally, such as:
- When physicians or other healthcare providers submit inaccurate documentation, medical billing professionals struggle to apply the correct codes and bill patients accurately. Handwriting mistakes caused by misreading may also lead to under coding (another lost revenue stream).
- Incorrect information for physicians, patients, and insurance providers is a common blunder. This knowledge, especially in an emergency, might take a back seat at a frightening moment and present a problem later on.
- Unbundling uses different codes for connected processes when there is a single code for the entire set of procedures. This illegal behavior raises the overall claim amount (and inflates your profit).
- Upcoding occurs when your team utilizes a billing code for a more involved or costly service than was performed. That includes tests conducted by technicians categorized as being driven by physicians. Because more strict regulations need higher fees, this massively increases your income.
- When patients are not charged for all the treatments or services provided, this is known as under coding. This unusual behavior may save a patient from a large charge or keep your emergency room from being audited. It also costs a lot of money to your EM group.
- Excessive use of the modifier 22- increased procedural services. Using this suggests that the patient’s operation took more effort than usual, which would result in a price rise. Adequate paperwork is required to get approval.
- Incorrect reporting of infusion and hydration codes. You’ll need correct paperwork for a start and stop timings to bill for these services without getting denied.
Consequences Of Coding Errors
Coding Errors Impact Patient Care
Quality patient care is the core of any practice. Incorrect medical coding may ruin that goal, causing frustration and misunderstanding, as well as the possible disintegration of the relationship you’ve formed with essential patients. Even though the repercussions of improper coding are rare, they do occur, and it is a necessary consequence to strive to avoid.
Incorrect coding can have a direct influence on a patient’s care. An excellent illustration of this would be using an incorrect diagnostic code. The accuracy of a diagnosis varies slightly among codes. Wrong classification of details during diagnosis might lead to poor patient treatment at another practice or for a specific service. A missing 2-digit modifier for a knee injury might result in an MRI examination on the incorrect knee. Consider how an incorrect diagnostic code may lead to an obstetrician delaying pain medication throughout a woman’s pregnancy. That is an extreme situation, yet it is unsettling and harmful to the sufferer. In instances similar to the above examples in your clinic, it may be time to investigate outsourcing medical coding to enhance code accuracy and prevent these significant mistakes from hurting your patients.
Coding Errors Delay Or Prevent Reimbursements
Medical coding is a practice’s lifeline and fail to submit accurate coding may result in delayed, refused, or curtailed payments. An alarming percentage of claims are rejected or denied upon initial submission. The compensation for refused claims is depending on the practice’s attempts to resubmit claim denials.
The payment for a miscoded operation might vary by up to $15,000. Delayed reimbursements are also expensive since they are unplanned. A backlog of late repayments can result in a backlog of paperwork, stress on your team, ignored coding problems, and even more wrong coding to be filed, all of which can lead to penalties. This backlog of claim denials caused by coding mistakes necessitates concentrated efforts to catch up on claim denials and enhance your revenue cycle. The healthcare revenue/reimbursement cycle is a unique machine. All aspects must operate together perfectly and at the right moment, or the system will fail.
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Billing Executive – a Medical Billing and Coding Knowledge Base for Physicians, Office staff, Medical Billers and Coders, including resources pertaining to HCPCS Codes, CPT Codes, ICD-10 billing codes, Modifiers, POS Codes, Revenue Codes, Billing Errors, Denials and Rejections.
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Learn More:
How to decode common Denial Codes in a Medical Practice
Complete Medicare Denial Codes List – Updated
CO 119 & PR 119 – Benefit Maximum for this Time Period has been Reached
Insurance denial CO 39: Authorization/Referral Problem
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