Medical billing and coding are complex processes. The cacophony of codes can pose a challenge for even the most well-organized billing department. Add to that the mix of grunt work carried out untrained staff in filling claims, inadvertent errors are almost an inevitable risk that can lead to loss of time and money in unimaginable proportions. Unfortunately, smallest of errors in medical billing and coding are blamed for most claims denial or delay in payment.
Moreover, frequent errors can negatively impact the relationship with patients. So how to avoid medical billing and coding errors? Are they avoidable entirely? Read ahead to know our 10 tips to prevent medical billing and coding errors and how your claims can harmonize with compliances.
A 2010 report by Office of the Inspector General, U.S Department of Commerce indicates that 42% of Medicare claims were inaccurately coded and 19% without necessary documentation. Therefore, medical billing and coding errors result in annual loss of revenue which runs in tens of thousands of dollars.
Since digitalization allows hospitals to employ coders from various locations or even different time zones, it can be a challenge to stay synchronized. This can cause many medical billing and coding errors which are otherwise avoidable. So, if you are still here to know how to prevent medical billing and coding errors, your answer is right ahead. Here are 10 best tips to avoid medical billing and coding errors so that hospitals can quickly get reimbursed -
A large chunk of errors can be prevented if a provider can verify the benefits at source where the patient avails a service. If a patient is a regular, it can be hard to resist using his recently entered information. However, it can lead to errors if there is a change in patient's insurance provider, the policy limit, or the terms of service. Whether the patient is newly registered or a regular, independently verify and communicate details such as authorizations, healthcare benefits, co-payment options, as well as the coverage term with the insurer. All these information plays a critical role while billing the patients without errors.
Trivial errors in patient's name, gender, and birthday can be grounds for claims rejection. Should the patient be dependent on the primary insurance holder, it is even more crucial to have a matching data which includes policy and group number.
Correct procedure codes and diagnosis are mandatory for the insurer to successfully reimburse the healthcare claims. The following circumstances may cause invalidation of claims -
Ensure that billing staff receives appropriate training in coding tasks. It is paramount for providers to use latest coding books for reference to avoid committing expensive errors.
When a medical practitioner writes a prescription in an incomprehensible way, it can result in claims being rejected. The staff responsible for billing must be trained to pose questions if they feel the codes are difficult to read. Alternatively, you can switch to automated billing systems. However, inadequate training to use the system may lead to more billing errors in EHR.
Turn to auditing so that you need not face hassles in the future related to double billing. This is one of the common errors because furnishing bills for canceled or rescheduled procedures can magnify the chance of claims being rejected. Carrying out chart audits can help prevent errors from proliferating.
Expect denial or delay of reimbursement when you submit incomplete data to payers. Omitting the inclusion of fourth and fifth digit, or not linking diagnosis code to Healthcare Common Procedure Coding System (HCPCS) code or Current Procedural Terminology (CPT) can impact the way claims are processed. In most cases, human error is the root cause of error, but they can also be due to inaccurate diagnosis information provided by physicians.
Upcoding can be deliberate or unintentional. It is a practice where comprehensive procedure is reported which starkly varies from the actual minimalistic procedure carried out by the physician. This causes compliance issue because payers will have to reimburse providers at a higher rate. It is best to furnish accurate codes to avoid claims rejection. If this practice is discovered, it can attract stiff penalties as well as audit.
Bilateral services and procedures such as X-rays, vaccinations, medications etc. must be explicitly highlighted so that the coders become aware that it is inclusive of the healthcare service. When coders work at a different location from the provider, the biller will not be aware of the bilateral services if the doctor forgets to mention.
It is a coder's responsibility to take precaution and ensure that every code is specific because some ICD-10 codes require the last two digits to be highly accurate to avoid healthcare claims from being rejected. Whenever coders face the dilemma whether the diagnosis is accurately coded or not, it is safe to refer the codebook.
Outdated reference manual can significantly impact the reimbursement process. It is important for coders to attend seminars so that their coding strategy stays up-to-date and relevant to [present standards. Having latest reference manuals aid in seamless processing of healthcare claims without delay or loss in revenue. Hence, it brings relief to both patient and provider.
Irrespective of the percentage of error rate, mistakes in medical billing and coding process can make insurers offer more money than what the provider is entitled so much so that it invites RAC audit to recover improper Medicare payments made to healthcare providers.
Incorrect and missing information are among many popular reasons why claims come back to provider. Valuable time and money is lost due to simple slip of fingers and the appeal process can be delayed. The key to avoid these top 10 medical billing and coding errors is to train your staff and use latest reference resources. This step alone can cut back the risk involved in reworking the process. introduce quality control measures in the workflow so that when final script if furnished, it is error-free, compliant, and accurate while covering all the procedures done by the healthcare specialists.
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