Medical coding errors lead to denied or delayed payments. Practices also lose significant time in tracking the source of the mistake. Since practices generate majority of their revenue through submission of CPT and ICD-9 codes to third party payers, physicians cannot afford to miss revenue opportunities due to coding errors.
Every single lost or delayed payment can affect the financial health of a medical practice. Therefore, accuracy in coding is necessary. Coders need to avoid some of the common mistakes in order to ensure a steady stream of payment.
- As per HIPAA rules it is mandatory for physicians and payers to use ICD-9 and CPT codes that are effective for the date of service. This means practices don’t get a grace period for deleting old codes from their claims. If they report old codes, it results in denied claims whereas failure to implement new codes leads to lost revenue opportunities. Therefore, practices need to make sure that encounter forms are up-to-date
- Insurance companies deny claims that are submitted for services that don’t meet the medical necessity requirements. Therefore, it becomes important to select the appropriate ICD-9 codes for the valid services and link them with associated CPT codes. If encounter forms are updated, this process becomes easier
- Practices also lose money due to under-coding. It is a challenging task to select and document the appropriate levels of E/M (evaluation and management) services. Physicians often make use of the 99213 code as they feel that coding anything higher will require extensive documentation. As per the national Medicare allowable amounts for outpatient E/M and patient office codes, the difference between 99213 and 99214 codes is just $33. This means that a practice can lose $165 per day or $40,000 a year if under-coding is done for five patients per day and 99213 is selected instead of 99214
- If physicians and coders are not aware of the modifier rules, it can lead to denied or delayed payments. Payers have improved the way they recognize modifiers when processing claims. This has made it important for coders and physicians to learn them and use them appropriately
- Wrong selection of codes also leads to errors and the practices have to bear the brunt for it on their revenue. In such cases, cheat sheets, inaccurate code descriptions, incomplete encounter forms and electronic charge systems are the main source of errors
Medical practices will be bringing in critical changes to their systems with the implementation of ICD-10. It has become necessary for them to focus on the coding basics and hire trained, experienced coders for obtaining maximum revenue.
But with the increase in workload due to stringent healthcare reforms, many physicians are outsourcing their billing needs to billing partners like MedicalBillersandCoders.com. Companies like MBC have a team of experienced and certified coders and billers who are well-trained in handling complex coding requirements. Their coders are also prepared for handling ICD-10 codes that are expected to disrupt the cash flow of medical practices. Billing companies like MBC help physicians streamline revenue and minimize claims denials caused by coding errors with guaranteed 25-30% immediate noticeable difference in the profits.