How to Avoid Medical Coding Errors

Medical coding refers to the process of standardizing the diagnostic procedures, medical services, equipment, and product records in two universal alphanumeric codes that are in compliance with state and federal regulations. The field is one of the most relevant and empowering for the health care industry today which is striving to go digital for greater efficiency and productivity across verticals. in many ways, medical coding can be set to be the backbone of any healthcare organization’s financial health.

Considering that medical coding is a recurring and intricate process, there is no doubt that there will always be a possibility of error. However, no matter how trivial they seem, errors in medical coding can lead to disastrous consequences in later stages, including claim denials, loss of revenue, penalty, and even poor patient relationships. This makes accuracy and reliability a must for a medical coding career.

in this article, we will be elaborating upon six ways to avoid making medical billing and coding errors, thus ensuring that there are no gaps in your revenue cycle or collections.

6 Tips for Avoiding Medical Coding Errors

Ensuring Accurate and Properly Aligned Patient Information

Accurate medical documentation is critical to the revenue cycle process in the healthcare industry because such detailed records can be used to validate reimbursements for issued claims. Healthcare organizations could face denied claims in case they lack accurate and complete records.

This is why the first step towards avoiding medical coding errors should be matching information correctly. This includes looking for incorrect or missing details in the patient’s name, address, birth date, gender, date of diagnosis or treatment, along with insurance details. Each or any of this could later become grounds for claim rejection in case your overburdened billing department fails to take note of fine details.

Refraining from Upcoding

Upcoding refers to the practice of a medical coder reporting a procedure with higher reimbursement costs compared to that which the patient has actually undergone. This most commonly happens when tests are performed by technicians but are wrongly credited to physicians, leading to extra charges. Either the billing professional has unknowingly attributed the task to the wrong person or has misinterpreted information being relayed to them.

In any case, this can lead to a bigger blunder and rejection of the claim, because it has illegally inflated your revenue. This is why it is important to keep a careful tab on who has delivered what service to which patient in the healthcare organization’s setup.

Referring to the Latest Medical Coding Guidelines

Medical coding regulations are fairly dynamic and constantly changing. If by chance, a hospital’s billing department fails to take cognizance of the latest issued guidelines, this can impact your reimbursement process in the later stages and lead to a denial of the claim.

Therefore, medical coding requires you to be up to date with the latest billing rules and regulations, which makes it important for professionals in the field to invest their time browsing the latest manuals, attending seminars, and keeping an eye on fresh news for the field. They should also spend some time refreshing their coding strategies, making this a field that promises constant learning.  

Checking for Duplicate Billing

It may so happen that a patient is billed multiple times by mistake, despite having availed the services just once, whether a diagnosis or a treatment. Such a trivial error can also end up magnifying into a bigger hassle of a denied claim in the long run, and many hospitals and clinics have often fallen prey to this. Not to mention, it creates a foul reputation for your organization as a fraud.

This is why it is important for medical coders to resort to frequent auditing to eradicate errors like this, which happen due to the frequent handling of large amounts of data in a disorganized manner. Chart audits that clearly place before you any discrepancies in calculations make this an easy task.

Validating Insurance Details in Advance

The most common reason for the rejection of medical coding claims is that the health care organization, hospital, or clinic was unable to verify insurance coverage at the right time. this is because insurance companies have unique policies depending on the type of service they are providing. these policies are also subject to frequent changes from time to time, irrespective of whether the patient has availed of their service frequently or recently.

this makes it important to independently verify the eligibility of each patient for the insurance concerned, besides determining the benefits and coverage of the policy in advance. these details need to be collated with the insurer along with co-payment options to avoid coding errors.

Outsourcing to a Professional Medical Coding Company

You can think of outsourcing your medical coding requirements to a professional and experienced offshore partner to be able to avoid common errors. This is because these companies have a talented pool of highly experienced experts in the field and constantly cater to a variety of organizations, which means they are always abreast with the latest developments or changes in compliances and regulations in the field.

Remote coding also enables healthcare organizations to use their space and resources for other infrastructure or service-oriented functions. Medical coding companies have increased security measures in place compared to a hospital setting with up-to-date disaster recovery systems to keep your medical documentation safe. Therefore, when looking to avoid common medical coding errors, what better way than to assign the task to a responsible and expert professional team?  

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