Medical Coding Mistakes that Lead to Loss of Revenue
It is true that with advancements of medical science, coding standards in US healthcare practices have evolved considerably. Every year we find changes in terminology by the AMA that detail out new coding standards on a periodic basis. It is also important to note in this aspect that coding is a specialized job that is done simultaneously with the billing process.
♦ Insurance companies that act as the advocate of the patients today with increasing regulations for reduction of fraud require optimized coding with claims submission that helps them in their adjudication process. Hence, avoiding common pitfalls that create hassles in reimbursements must be avoided during the medical coding process.
♦ Another critical aspect these days is the arrival of ICD-10 standards that is demystifying the world of coding. Today, medical coders must have the necessary skill-set to have quality practices with the right certifications in place.
Some of the mistakes that need to avoid by medical coders today will be
Noncompliance to HIPAA : Sensitive patient information & its secrecy must be of prime concern for the coders. Your team of medical coders must adhere to the best practices that will allow them to find relevance with the payors during their assessment of claims.
Avoiding down coding & up coding : Setting malpractices with coding by claiming less or more with claims reimbursement is often utilized by providers to generate quick realization. However, this practice can result in serious fraud & can be detrimental to the practice’s future in the long run.
Coders lacking proper certifications : One of the advantages of having proper certifications like CPC & CCS is the coders have esteemed practices with coding. They have a comprehensive understanding of the payor’s requirements that makes them keep quality methodology in their coding standards.
To be ill-informed: Staying updated with newer standards in coding in services, procedures as well as diagnosis should be the key motto of an accomplished coder. Today, understanding of ICD-10 CM, ICD-10 PCS as well as HCPCS level II is a must when it comes to real-time coding.