Accurate coding and billing processes are the core elements for a successful compliance program for healthcare providers and physicians which can translate into a successful Revenue cycle Management process leading to enhanced revenues. It involves appropriate and precise application of billing codes, diligent documentation of medical records, and correct charging for medical services rendered. But, within this loopholes do exist, and these cracks can lead to major financial losses affecting the Revenue Cycle Management (RCM).
Simply by monitoring and auditing medical claims filed, loopholes can be minimized and correct medical billing and coding can be ensured. Pro-actively working in tandem with regulatory guidelines and compliance policies of the industry, will ensure and translate into dollars.
Here are some simple tips to minimize the loopholes when billing
|Wrong Codes for diagnosis, referrals||Always double check and audit that the right codes have been attached to the various diagnosis/ coding an office visit as a consultation and not as a referral.|
|Under coding and up coding/ overpayment or improper payments||Insist on audits and bill only for the service provided and check manipulation of billing for equipment and medical supplies.
Also be careful when unbundling or billing each component of a multiple component service as a single service.
|Manual documentation||Automate the documentation process right from scheduling of the patient to billing forms, application of diagnosis, service and procedure codes.|
|Unaware of Regulations and acts and laws in the healthcare industry||Medical billing codes change over time due to modifications in healthcare regulations, illnesses & treatments.|
|Letting slip the EOBs and denied claims||Keep track of denied claims with follow-ups on EOBs attached to claims|
- Optimize the claims audit processes
- Automate and speed up various audit processes to enhance cost efficiencyIdentify consistent patterns of coding and billing errors
- Introduce a well-integrated training program with focus on coding and billing
- Enhance document and data management
- Provide technology-enabled tools
- Implement both corrective & preventive action processes
- Keep track of denied claims from insurance companies
Keeping these simple tips and integrating them into your workflow and Revenue Cycle Management Process, the loopholes can slowly be weeded out of your system.