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Health and Medical

Role of Medical Coding Services in Bringing Down Claim Denials

Who is taking care of the coding process at your practice? More and more providers are switching their process to medical coding services nowadays. Can you guess why? Both the government and commercial payers are tightening their grip over the coding nuances day by day. With this going on, claims are getting denied for the slightest disparities in the coding process. We all know, medical coding is the conversion factor between services provided and billable revenue. This is why one cannot compromise on sloppy coding practices. 

Consequences of wrong coding practices

It is known that coding errors and lack of compliance are the major reason behind claims getting denied. Though committed deliberately or unintentionally, improper coding practices are considered a grave mistake. When claim denials keep piling up, practices run of profit soon. Every denied claim is a service unpaid. It is impossible to take the practice forward when most claims remain unpaid. This stresses the need for outsourcing to medical coding services furthermore.

Moreover, errors committed with coding are putting practices into serious legal risks these days. Such errors are considered as medical fraud and abuse which has dire consequences. Often, the provider comes to know about it only when there is a call for Federal audits or payer audits. If found guilty, authorities may demand huge amounts of penalties. Now, this will make the insurance companies lose their trust in the practice. The reputation of the practice also goes downhill. 

Frequently committed coding errors

Coding errors can be of many types. Starting from lack of experience by the coder to missing data, anything could go wrong while coding. Medical coding services often list out some critical areas where errors could happen. Let’s look at the common coding mistakes committed and how they happen;

Poor documentation practices –

The coder solely depends on the health record chart prepared by the provider for coding. If the chart is incomplete, confusing, and illegible, chances are, the coder might assign totally wrong codes for the services provided. It is very important for the providers to document the disease condition, diagnosis, treatment plan, procedure information, etc. without ambiguity. Also, there are other critical areas like demographic information of the patient, place of service, date of admission /procedure, past medical conditions, and more. 

Medical coding services recommend that the providers at the facility undergo a training session on proper documentation practices. This way, the coding team can do their best at deciphering the healthcare data and come to the correct conclusions while coding for claims. Even when the details of the providers involved in the care are omitted or if they have not authorized the chart properly the document stay incomplete

Upcoding

this is the scenario where the provided service is projected as a more complicated or extensive one than what it actually was. With this, the treatment code is exaggerated as a more expensive one compared to what was provided to the patient. Similarly, when the procedure is conducted by a technician might get coded as by a doctor. Clearly a wrong coding practice.

Under coding

this is when services provided go uncoded in the final claim. Maybe the provider failed to document the billable scenario or the coder failed to identify the service as codable. This happens sometimes in emergency situations, where documents are recorded in a hurry. Either way, a code missed is a service unpaid. Sadly, the practice loses revenue over the valuable effort taken and time spent. There is another fraudulent coding activity detected where a code is omitted on purpose to show that a particular treatment was not conducted. Sometimes it is done to favor a patient regarding expensive bills. 

Unbundling errors-

another fraudulent activity with coding is unbundling of services. Here, a procedure that needs to be represented by a single code is split into tiny steps. Each step is assigned separate codes as well, so that the claim amount is higher than what it actually is. This is totally illegal, and if caught by the authorities, a clearly punishable offense. 

Duplicating

this is billing malpractice where the same service is projected as multiple occurrences. Sometimes, practices bill for the same procedure with different dates of service so that the claim is higher. 

Errors with specific codes for intravenous infusions

it is known that intravenous infusion or drugs, electrolytes, blood products, etc comprise very specific codes based on starting time and stopping time as well as reputations of hydration required. Practices are found manipulating these codes by tampering with the actual information.

Excessive use of code modifier 22

when some procedure requires some extra services and timespan, the additional effort can be billed by projecting it with code modifier 22. But providers overuse this modifier often to get increased claim rates. 

From the possible errors listed above, it is evident that it takes a good amount of knowledge, experience, and frequent training to get the coding process right. This is where medical coding services come to the rescue of the providers. Because in the end, it takes a bunch of talented professionals to create an impeccable claim.

Practolytics

Practolytics is a 20+ year old healthcare technology and management company. We partner with healthcare practices to provide end-to- end solutions including medical billing, healthcare consulting and practice analytics, allowing practices to eliminate revenue cycle management inefficiencies. Our diverse background in every aspect of healthcare allows us to maximize revenue and consistently deliver optimum results.

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