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Employ Coding Best Practices for Maximum Reimbursement

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To be financially successful, practices must find ways to lower costs and increase revenue. With rising business costs, it is imperative to capture every dollar by plugging all sources of revenue leakage. It is the diagnostic and procedural codes submitted with claims that mandate the quantum of reimbursement paid to physicians for services rendered.

One of the significant areas of concern for practices is incorrect medical coding and consequent rejection of claims. Further, lack of follow-up results in the ballooning of accounts receivable. A substantial amount of AR is never collected from payors.

Coding errors can cost practices thousands of dollars and consistent coding errors can lead to compliance issues. A few of the most common coding errors include the following.

  1. 1. Not coding to the highest level: When coders are not thorough with medical terminology or have not taken accurate notes, then the coding is not done to the highest level of specificity.
  2. 2. Inadequate documentation: When the documentation sent to the billing/coding staff is insufficient, it is difficult to assign the correct codes. Misreading a provider’s handwriting may also result in undercoding.
  3. 3. Unbundling: There may be a single code for a group of linked procedures. Using different codes for these procedures is called unbundling. This coding error is illegal.
  4. 4. Upcoding: Using a code for a more expensive procedure than what was carried out is called upcoding. It also includes tests done by techs being coded as done by physicians.
  5. 5. Undercoding: This happens when all the treatments and services rendered are not coded and billed.
  6. 6. Using modifiers incorrectly: These include appending inappropriate modifiers, overusing modifier 22, improper reporting of infusion and hydration codes and injection codes, reporting unlisted codes without proper documentation.
  7. 7. Failure to use updated codes: All code sets undergo revisions and modifications regularly. Coders must be constantly educated on these changes.

To avoid rejection of claims and, more importantly, compliance issues that can become severe, some best practices to be employed are

  • Educate coders: CPT and HCPCS code sets undergo constant revision. Coders need to stay abreast of all changes in codes and regulations.
  • Coders need to self-check: Coding, once completed, must be rechecked by coders for accuracy.
  • Coding Audit: An internal audit team that checks the correctness of coding will go a long way in eliminating coding errors.
  • Regular training: To avoid upcoding and undercoding and to code to the highest level of specificity, coders must be trained regularly. It is essential to ensure that complacency does not set in at any time.

Eliminating coding errors is no small feat. For this, a lot of work and resources are required. Outsourcing your coding requirements is, therefore, a prudent choice. Bristol Healthcare, a billing and coding company, is here to assist you. By partnering with us, you will benefit in the following ways

(a) High coding accuracy

(b) Lower operating and administrative costs

(c) Better cash flow

(d) Increased revenue

(e) HIPAA compliant

(f) Improved patient care

(g) Enhanced patient satisfaction

It is not just coding; we can help you with the entire revenue cycle. Our certified and trained billing team will customize solutions as per your requirements. Rest assured that your back-office headaches are a thing of the past.

Allow us to take your practice to the next level!

Talk to an expert today!