Medical coding transforms healthcare diagnoses, medical equipment, and services into universal alphanumeric codes. In other words, medical coders abstract information from patients’ medical documentation, assign appropriate codes to various procedures and create a claim to be paid by the insurance carrier. Hence, such professionals help ensure that proper codes get applied during the billing process.
Importance of Accurate Coding in Claim Denial Management
Medical coders are crucial to maintaining patient safety while treating medical conditions. They obtain information from various sources, such as medical record documentation, reports, transcripts, etc., and assign appropriate diagnosis and procedure codes.
Medical service providers have contracts with insurance companies. Contracts specify negotiated rates for various medical procedures and treatments. Accurate coding and billing ensure practices are in contract compliance, making it vital for medical billing.
Claim denials negatively impact your reputation as a healthcare provider, besides affecting the patients’ experience. Perfecting the medical coding process is thus crucial as it helps prevent rejections.
What are the Common Coding Errors?
Inaccuracy in coding is the primary cause of claim denial. Research indicates that healthcare businesses lose over $8 billion on claim appeals every year.
Typical errors in medical coding include:
- Using multiple Current Procedural Terminology (CPT) for coding.
- Documenting codes for diagnoses and procedures not covered by the insurer.
- Reporting individual components of a procedure with different CPT codes.
- Overusing or adding a false modifier.
- Incorrect reporting of hydration, infusion, and injection codes
- Undocumented reports of codes that are not listed.
Correct and accurate coding certainly benefits providers and practices in one or more ways:
- Accurate coding helps the insurance provider know what the patient is getting treated for and the coverage sought.
- Accurate coding offers many benefits, such as faster treatment, specialised diagnostic tests etc.
- Accurate medical codes help assess patient health, identify healthcare quality issues, and even influence public policy.
- Accurate coding and documentation ensure prompt and accurate reimbursement of claim payments and avoid denials.
- Accurate medical coding helps the billing department create error-free bills.
How to Code Accurately?
A study by the Healthcare Financial Management Association (HFMA) shows that 90% of denials can be prevented. Providing proper and comprehensive documentation of provider services is one way to eliminate medical coding errors.
Most medical coding services guarantee accuracy through outsourcing. Healthcare businesses lose revenue and credibility due to incomplete or incorrect medical records. This is where clinical documentation improvement (CDI) can be critical to the healthcare revenue cycle. Also, information can be encrypted accurately by ensuring that coders use the CPT/HCPCS codebook correctly.
Tips to Improve Medical Coding
- Update with Coding Rules
Medical coding guidelines and mandates change frequently. Coders should be trained and knowledgeable in traditional and modern coding techniques, ensuring that they follow the necessary standards and practices.
- Periodic Review
The coding team must often brainstorm to evaluate coding rejections. These sessions will help identify the root cause of coding rejections. As a result, irrelevant codes or inappropriate clinical documentation sources can be corrected for more accurate results.
- Assessment of Patient Data
Most claims get rejected because of incorrect patient data. These errors occur when the data is not verified. Hence, patient data, including their insurance details, must be screened for authenticity.
- Co-sourcing Standard Services
Many specialised service providers are equipped with the necessary resources and skilled medical coders support for medical billing and coding services. They use the latest standards and clinical documentation. A nominal fee is charged to ensure that accurate medical coding records are available, thus guaranteeing error-free coding.
- Checks During the Submission Process
A detailed review of all documents and reports before submission mitigates the risks of errors in the system. For instance, fixing and correcting patient information may save on overheads in the early stages.
While providing accurately verifying patient details, coders must follow the tips listed below to improve their coding practices and limit rejections.
Hospital and Healthcare service providers are taking advantage of technological advances to enhance documentation and coding quality. Computer-assisted coding (CAC) software is crucial in increasing coding accuracy while enhancing healthcare outcomes. Consequently, choosing the best-fit technology solution provider is necessary. Organizations must partner with a multi-pronged and prospective vendor to achieve excellence in the medical coding process and dramatically reduce claims denials.