Why is the work of medical billing professionals so important? It has to do with the consequences of inaccurate coding and incorrect billing. Inaccurate coding and incorrect billing can cripple health provider businesses, so it’s essential that medical billing is always taken care of properly. The claims submitted by your medical billing department must always be accurate and free from mistakes. Even the slightest error can lead to payment delays, claim denials, and other consequences of inaccurate coding and incorrect billing.
As a health provider, you must ensure that your company’s medical coding and billing are expertly done. Are you looking for some help in this area? Contact CodeMax Medical Billing today by calling 866.471.3267 or filling out our online contact form. Our medical billing professionals are standing ready to help you with coding and billing.
What Are Examples of Inaccurate Coding and Incorrect Billing?
Generally, medical billing and coding are how you turn the services your practice provides into billable revenue. Each service you provide corresponds to certain Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes. Claims for these services are submitted to Medicare, Medicaid, insurance companies, and other similar agencies with these codes.
Some common examples of inaccurate coding and incorrect billing issues that may affect your practice include:
- Missing documentation- Sometimes, there’s not enough information about procedures performed by healthcare providers to allow medical billing professionals to properly file a claim. Healthcare providers may leave crucial details out of the reports they file or even provide illegible medical reports.
- Not coding at the highest level of specificity- This happens when the medical billing professional handling a claim doesn’t find the information they need in medical reports from the provider. Coding to a general level of specificity can lead to a denied or rejected claim.
- Not having an easy way to contact the health provider- Medical billing professionals should have easy access to the healthcare providers they’re doing work for. However, this may not be the case for some. Healthcare providers may not always be available to consult and clarify complex claims.
- Not using current or updated code sets- The organizations that maintain the principal medical code sets, which are the World Health Organization (WHO) for the International Classification of Diseases (ICD), the American Medical Association (AMA) for CPT, and Centers for Medicare and Medicaid Services (CMS) for HCPCS, update their manuals yearly. It’s up to coders to learn any new or reorganized codes as they come out and then use them correctly.
- Undercoding and overcoding- Undercoding is defined as the purposeful reportage of less expensive medical services than were actually performed. Overcoding is the opposite, which is the purposeful reportage of more costly procedures than were actually performed. Both practices are fraudulent and can lead to investigations and audits.
- Unbundling- As with undercoding and overcoding, unbundling is not really an error in medical coding as it is a fraudulent practice. Unbundling may be related to upcoding in that it usually involves false reporting designed to earn the healthcare provider a higher payout. Unbundling involves separately coding certain medical procedures that would normally be put together under one umbrella code.
What Are the Consequences of Coding Errors?
The consequences of billing and coding errors include delays in reimbursements. Some claims may also be denied or only partially paid. When your practice builds up delayed or denied reimbursements, there will be so much additional stress and paperwork added to a typical workday. You may lose revenue and find it more challenging to do your work.
Apart from problems with reimbursements, there are many ways that inaccurate coding and incorrect billing can harm your practice, including:
- Lengthy claim processing time
- Charges of abuse or fraud, resulting in fines
- Audits made by insurance companies
When medical billing and coding are always correct, these troubles can be easily avoided.
Learn More About the Services CodeMax Medical Billing Offers Today
Medical billing and coding can be an excessive amount of work, and you don’t rush doing it. Even the most minor errors can result in harmful consequences of inaccurate coding and incorrect billing. When a healthcare practice outsources its medical billing and coding, fewer mistakes are made, and patients receive better care. If you’re looking for professional help, contact CodeMax Medical Billing today by calling 866.471.3267 or completing our online form.