Many healthcare providers outsource the services of medical billing professionals because balancing the provision of high-quality patient care with completing necessary administrative tasks can be challenging. If the balance isn’t kept, the risk is high that a healthcare facility’s reputation and revenue go down.
Medical billing can take up a lot of time, and doing it in-house takes a lot of effort. Some facilities have a separate department or a particular employee taking care of it. However, it can be difficult to find and train people to handle this crucial task. This is why many healthcare facilities turn to third-party medical billing services to handle claims management. If your healthcare facility is having trouble managing medical billing and coding services in Tennessee, contact CodeMax Medical Billing today by calling 866.471.3267 or completing our online form.
What Are Medical Billing Services?
Medical billing services process and submit health insurance claims. Whether these services are within a healthcare facility or through a third party, these services are done by specially trained staff members who are knowledgeable and can work within each insurer’s specific policies to get a higher level of payment in a shorter amount of time. Medical billing services also include following up on rejected claims and pursuing any delinquent accounts.
It’s vital to remember that medical billing is a different service from medical coding. Some medical billing companies may offer both services, but many will require healthcare facilities to do their own medical coding. Medical billing is the actual processing, submitting, and following-up of claims. In comparison, medical coding involves assigning standard codes to individual services in preparation for submitting health insurance claims.
What Are the Consequences of Inaccurate Coding and Incorrect Billing Services?
Inaccurate medical coding will cause reimbursements to get delayed, denied, or only partially paid. With inefficient medical coding, you can build up a collection of delayed reimbursements. The consequences of coding errors for healthcare providers include mounds of paperwork, extreme stress, and lost revenue.
If a healthcare facility develops a history of incorrect coding and medicine billing mistakes, it may be scrutinized for medical abuse and fraud. The facility can face severe federal fines and penalties. Medical abuse happens when a claim is falsified and leads to a healthcare facility’s monetary gain, either unintentionally or deliberately. Medical abuse is considered fraud when there’s evidence of intentional misrepresentation across many patients over a long period. Defrauding any government healthcare benefit program can result in penalties that can include imprisonment.
Every piece of your claim has to be accurate for a smooth reimbursement. But your team may be committing some common medical coding errors intentionally or unknowingly, including:
- Duplicate billing – When your staff bills the same patient for the same service multiple times even though it was only performed once, duplicate billing happens.
- Hurried intake and missed information – Entering incorrect details for healthcare providers, patients, and insurers is a common mistake. Information handling can take a backseat to physically helping a patient, especially in emergency situations, which can cause issues later.
- Improper infusion and hydration code reporting – To avoid a denial for billing these services, you’ll need accurate documentation of start and stop times.
- Overusing modifier 22 for increased procedural services – Using these services means that the patient’s procedure required more work than normal, resulting in a price increase. Doing this requires proper documentation for approval.
- Sloppy documentation – When medical professionals turn in sloppy paperwork that’s close to unreadable, it’s difficult for medical billing specialists to assign the right codes and then bill patients correctly.
- Unbundling – Using separate codes for linked procedures when there’s a single code for the whole group of procedures is known as unbundling. Doing this is illegal, as it increases the total claim amount and inflates your profit.
- Undercoding – This error happens when patients are not billed for all of the treatment or services rendered. Also, undercoding may help a patient avoid a high-cost bill or help your healthcare facility avoid audits.
- Upcoding – This error happens when your team uses a billing code for a more complicated or expensive service than what was actually done. Since more serious codes demand higher payments, this also illegally inflates your revenue.
How Do You Avoid the Consequences of Coding Errors?
It’s easy to avoid the consequences of inaccurate coding and incorrect billing. Just make sure that the medical billing and medical coding services you use are effective and efficient. If doing them in-house is proving difficult for your staff, turn to third-party companies that are experts at providing these services.
However, it’s important to note that not all medical billing and coding services are created equally. There’s a critical distinction between outsourcing and offshoring. The former involves contracting work to a specialized organization, while the latter involves getting the work performed in a different country. Despite the competitively low prices, offshored medical billing and coding partners are much less likely to be efficient and compliant than services in the United States.
Choose CodeMax Medical Billing for Medical Billing and Coding Services in Tennessee
When choosing a partner for medical billing and coding services in Tennessee, turn to our team at CodeMax Medical Billing. Learn more about our Tennessee medical coding services today by calling 866.471.3267 or completing our online form.
