Medical billing and coding are done by specialists known as Health Claims Specialists or Medical Billers and coders. These mistakes are common and these mistakes can cause a lot of problems. Some common mistakes that have been noticed are mentioned below with there solution.
Dishonesty in Medical Billing and Coding:
Certified medical coders and billers are trained to abstract billable procedures from their medical records. A true medical coder and biller always respect the rules of coding.
The biggest rule is that all procedures coder submit must be documented as a record, not only mentioned in the heading or somewhere else. Therefore, resist the temptation to submit codes that are only implied or that are not documented by necessity.
Don’t unbundle any codes for the sake of additional reimbursement and don’t choose any procedural codes that is like the actual service performed. Code honestly, code accuracy and the medical coder and biller will have to do just fine.
Transfering the Blame:
Medical coders and billers have nothing to obtain from transferring or shifting the blame of inaccurate coding or billing on the others as it is there on duty.
If the medical coder works in an environment with a department of each step of the coding or billing cycles, ask for clarification as to how much leeway medical coder has to facilitate. If the medical coder notices any claims are not being submitted in a timely manner pay attention and ask for details about it.
As the entire revenue cycle details collection is his job, then he must take responsibility to ensure that the claims are moving as they should through the cycle. To maintain the integrity and respect of superiors and co-workers ie their team and focused on the bottom line revenue for your clients.
Billing and documents more than once:
Medical coders have to focus on the dates and times of the bills to avoid billing twice or more. Physicians often dictate every step of a procedure, but that does not mean that each step is actually billable as a few steps may have no price.
To be eligible for separate reimbursement, the procedure must have to be required additional work and skills by the medical practitioner. Stick to the providers ie clients documentation to bill exactly what you need to ie is no more addition or any subtraction from the bills.
If the documentation is ambiguous take your time to clarify that what occurred with the medical practitioner. If any issue is still unresolved then go towards the practitioner and ask to clarify it.
Codes that are bundled are considered to be incidental to another billable procedure. For Example, any surgeon must make an incision before its surgery is performed. The incision is incidental and the surgeon must have to close the incision.
Again, a normal closure is incidental because it is necessary to complete the basic procedures. The medical practitioner often fully documents these approach and the closure but that does not mean that the medical coder charge any additional bills for that.
The key is to know what are the procedures which can be done for these cases and is they have any additional cost or is there any additional bill can be made or not, If possible then it can be added.
Ignoring any Error of Medical Billing and Coding:
Commonly the documentation has an error. Perhaps it’s a transcription error or omission by the clients. Either way, the medical biller is responsible for bringing any error in it. So pay attention to the documents provided by any physician and check the outpatient name or spelling error.
Ask the client to make it correct if it looks legal or try to get details from the physician which is helpful for medical coders. In all cases, you have to find and correct any error if exists. Try to recheck the bills and documents again and again for confirmation.
Mismanaging of Overpayment :
Occasionally, a payer fails to process any of its claims correctly, with paying too many bills mostly or sometimes too little amount. If a claim has been underpaid which is not so much common the provider ie client is quick to ask that the error be rectified at that time as it is easy at that time.
When a claim has been overpaid the medical coder should follow the same policy and it should be implemented.
If a payer has failed to follow the contracts and allowed more than the contract obligates, the clients should notify the payer and should prepare to return the amount where the error is found in the payment. Doing so reinforces medical coders that the payer finds and error and ask about reimbursement.
Sometimes failing to protect patients from penalties which are out-of-network:
Most patients are not so experts on insurance plans or the medical claims processes. If a client treats patients out of network the patient often faces penalties in the form of high amount of deduction.
Some plans don’t cover these out of network services at all. The patient is commonly responsible for the costs of the entire.
To protect patients from these times of conditions, providers should have office policies. That defines how out of network patients are to be billed.
In addition and whenever possible, the medical coder should have to verify the patient’s benefits prior to any encounter and explain its deductibles and co-insurance responsibilities.
Also Read: Blood Blister
Medical Billing and coding Fails to verify Prior Authorization:
Before they can be performed, some of the procedures require the providers receive prior authorization. Which is permission from the payer for the patient to be treated in that.
Failure to obtain any necessary authorizations or referrals can result in the claims being denied. Depending upon provisions of the patient’s plan, liability for any billed charges then falls on either providers or the patient’s.
For these reasons, checking it that whether planned procedures need prior authorization is a vital fo ensuring that the provider adheres to the contract he/she has with a payer and receives the negotiated reimbursement for the services which he/she provides.
Always ask the physician to note any and all procedures that may be performed and check the authorization as it is necessary in all occasions.
Breaking confidence of the Patient:
As the medical coder, you must access to both the patient’s clinical information and his or here personal demographic information. Such as Social Security numbers, date of birth, permanent address, and so on.
It may go without saying that the medical coder needs to protect this information. As a medical coder would your own, not only because of threats of identity theft. Also because of the ramification of violating of Health Insurance Portability and Accountability Act. Which is not so much common but may happen sometimes.
HIPAA ie Health Insurance Portability and Accountability Act governs to whom, under what circumstances. What kind of information medical coder share about a patient. Violators may be subjected to steep fines and the possibility of imprisonment for these kinds of acts.
Following the lead of an Immoral Manager:
Most of the coding managers know about and adhere to correct coding processes. Expect you to follow those processes as well.
Unfortunately, you may encounter a manager who may have less aware of correct coding rules. May cognizant of the rules, or tents to bend or overlook them.
These coding managers may look after modifiers as a tool to increase reimbursement. Rather than a tool to increase specificity when reporting services.
If your manager or any other person related encourages you to code out of bounds don’t acquiesce. Instead, do what you think is right for you and report the incident to an office leader. That may be the manager or any other person who can follow up on these types of matters.
You may get on the shady manager’s bad side. You will be able to sleep much better at night. As it increases your confidence and resolves your issues related to it.