Medical billing and coding are the critical processes of Revenue Cycle Management. The sheer complexity of coding and billing can pose several difficulties to even an experienced organization. In the absence of well-trained and certified coders and billers whose knowledge is not up to date, errors of all types are bound to occur, which will adversely affect the turnaround time and ultimately clients’ revenue. Further, there are compliance issues to watch out for and up-coding is to be avoided at all costs.
Medical Billing and Medical Coding companies with broad experience and knowledgeable billing/coding teams have evolved to avoid medical billing and coding errors. It is pertinent to note that a report in 2010 by the Office of the Inspector General from the United States Department of Commerce indicates that 42% of the Medicare claims were not coded correctly while another 19% did not have the necessary documentation.
Listed below are some well-documented and proven methods of avoiding coding and billing errors.
Check the insurance benefits of the patient
The insurance benefits that a patient is entitled to must be thoroughly checked before the patient’s visit. Knowing a patient’s financial responsibility for the medical services to be rendered makes it easier for the patient and provider. Further, discussing with the patient what would be the amounts they would have to pay helps them to plan for it. This thorough initial check of the patient’s insurance policy, the benefits entitled to and the patient’s expected out-of-pocket expenses result in lesser errors while preparing claims. At the same time, providers can be assured of recovering dues from patients when they are made aware of their responsibilities.
Check the demographic information of the patient
Any misrepresentation of information can lead to claims being rejected. Errors frequently arise while registering patient information related to the patient’s name, insurance information, address, gender, and birth date. Names should be spelled correctly and the data on the insurance form must match with the data on the social security card. Although it appears self-explanatory, it is crucial to enter demographic details accurately. Mistakes can lead to the rejection of claims.
All information entered in the claim form, such as patient information, procedure code, diagnosis code, and number of units allowed, must be given a recheck before submitting to the payor. Claims get rejected mainly for the following reasons.
• Incorrect codes
• Authorization not obtained
• Treatment not covered by insurance
Having a competent billing and coding team is paramount for providers. Their knowledge must continually be updated with the changing insurance guidelines to eliminate errors in billing and coding.
Ensure no duplicate claims
Duplicate claims are caused by double-billing and arise primarily due to
• Billing for the same patient procedure, treatment, or testing more than once
• Bills for the wrong patient service
• Bills for patient services not done
• Charges made twice for the same service
Such duplicate billing, if occurring frequently, can lead to regulatory issues with government agencies.
Ensure completeness of the claim
A claim will get denied if the claim is incomplete and submitted to the payors. Not including the fourth or fifth digit of the dx code, incorrect procedure code, mistakes in the patient/insurance information or any other necessary information can result in the rejection of claims. Check and recheck that the claim is complete, correctly coded, and submitted within the time-frame stipulated by the payor. Quick reimbursements can thus be ensured, resulting in commendable RCM outcomes.
Upcoding is the process of reporting a complex procedure in place of a minimalistic procedure done by the provider. While this can be intentional or otherwise, it can result in the payor paying more to the provider. If the payor is then notified of this, it can lead to legal complications and loss of the provider’s reputation. It is best to be careful and code precisely to the service rendered to the patient.
Highlight Bilateral services
Any service is done to both sides of the body, such as both arms/legs/ears, is mentioned in the claim form as bilateral service. Bilateral service is nothing but one single service to be done on both sides of the body and is represented by the modifier 50. Bilateral services must be marked in the medical records for the coding team and billing team to identify.
Ensure the correctness of Specific Coding
An expert coder will review the medical records and choose the codes that correlate to the patient’s medical procedure. Some ICD-10 codes require the last two digits to be accurate as possible to avoid rejections and denials. The coders invariably look into the ICD-10 codebook to understand if a code is correctly applied. Specific coding is the hallmark of a good medical billing company as it reduces the denial rate substantially. Coders have to stay up-to-date regarding changes made to all the codes and changes in industry regulations and guidelines.
Bristol Healthcare will help with your billing and coding
Bristol Healthcare Services is a California-based medical billing and coding company, serving healthcare professionals for over 20 years. Our mission is to serve our clients with integrity and a passion for giving more than expected.
Our company values compliance and the safety of patient information. We have invested in people, hardware and software so that our clients receive superior services. Our workflows are designed to produce error-free claims for faster payments.
We take great pleasure in seeing our clients grow their practice with our assistance!