How to Save Your Medical Practice from Coding and Billing Errors?
Medical Coding and Billing errors are potential dampeners – hefty amount of money may be lost due to mistakes in billing and coding, causing physician groups, clinics, and practices to lose revenue – not to mention legal penalties and hassles. Using correct coding and billing and thus avoiding the unwanted repercussions are of paramount importance in health care facilities.
Role of Medical Coding and Billing in Medical Industry
Medical coding and billing are considered significant and closely related aspects of contemporary health care industry; they play crucial roles in the Revenue Cycle of medical practices. Both processes are directly associated with the vital reimbursement cycle that ensures payment to care providers toward services offered. The success and financial wellness of a medical practice greatly depends on effective and error-free Medical Coding and Billing processes.
Common Mistakes that Crop Up in Coding and Billing Processes
It is imperative that medical practices perform their coding and billing functions at the highest accuracy level possible. Coding and billing errors often not only lead to loss of revenue but also impact in other ways. Following are certain common mistakes that could cause unwanted consequences:
- Incorrect Insurance Information: This would lead to delay in patient care, as patient’s insurance data cannot be properly verified prior to treatment, and result in delayed payment to the practice, if patient has been treated without verifying insurance information
- Improper documentation of services: claims could be denied or delayed if services provided are not documented appropriately
- Using Outdated Codes: Failure to update and adhere to latest CPT or ICD codes, or failure to use modifiers as and when required, may impact the payment
- Overcharging the patients: Patients’ wrath needs to be faced when incorrect billing and coding practices lead them to believe they have been overcharged
Billing Errors that must be avoided
- Upcoding
- Duplicate Billing
- Missing or incorrect written information
- Inflated O R charges
- No plan for handling denials
- Insufficient staff to handle billing and coding tasks
How to Avoid Coding and Billing Errors
Delayed payments and denials are often caused by simple errors and lack of applying caution on the part of coding and billing staff. By following certain steps diligently, billing and coding errors may be eliminated.
- Using proper medical coding and billing: Correct billing and coding ensures smooth claims processing
- Verification of every medical billing claim: Each claim needs to be double-checked
- Understanding individual medical specialties: Employing only certified coders and training and educating them on regular basis helps reducing mistakes in coding and billing
- Constant monitoring of changes in legal regulations: Regular monitoring and taking subsequent steps to ensure adherence with health care laws and regulations and compliance with HIPAA and Medicare helps accomplish control
Sound procedures and policies must be followed, coding and billing plan needs to address periodic reviews, and reviews must be conducted to ensure correct medical coding and billing practices in health care facilities.
How Does Medical Billing Differ From Coding?
Although there are similarities between the two, medical coding and billing are in fact two separate processes. Contrary to common belief by people, they are not one and the same. In both the processes, professionals happen to work in health care setting, gather health information from the patients, and confer with physicians and insurance companies. The similarity ends here.
Fundamental Functions of Medical Coders
Medical coders are entrusted with the determination of the procedures that have been performed by the physician, surgeon, or other member of the health care team. They then assign the diagnosis code or proper procedure code for the corresponding services provided by the medical professionals to the patient.
Medical coders make use of Current Procedural Terminology (CPT) for allocating codes related to procedures received by patients; they refer to International Classification of Diseases (ICD) for choosing the diagnosis code for labeling the concerned physician’s diagnosis about patient’s condition. Coders are expected to assign perfect codes as these will be used as base by insurance providers toward patients’ insurance claims.
What do the Medical Billers do?
Medical billing involves entering codes into specific software and then processing insurance claims. Medical billers use special billing software that lets them enter the codes that are assigned by coder as well as other relevant information- facilitating sending the claim to insurance company for payment.
Entrusted with the process of dealing with insurance providers, medical billers are expected to have complete knowledge of the claims process and all requirements that need to be submitted for processing claims. The responsibility of handing proper insurance claims lies with them too. In this connection, they must ensure that correct billing format is followed, all fields have been answered properly, and all supporting documents are included in the file.
Distinct Processes in Medical Coding
It is the medical coder’s responsibility to decipher documentation of patients’ interaction with care providers such as physicians, surgeons, or nurses – they determine appropriate diagnosis and procedure codes for reflecting the services provided.
Exclusive Tasks in Medical Billing
Medical biller takes the assigned codes along with necessary insurance data, inputs them into the specific billing software, and submits claim to the payer (which is mostly an insurance company) for payment. Moreover, billers need to follow up on the claim as and when required.
To put it shortly, medical coders and billers are entrusted with the task of collecting information, coding claims, and arranging payment for physicians in timely manner. Both these roles are crucial for practice cash flow.