17 Apr Five Reasons Why Medical Coding Errors Occur
If you’re a practitioner handling medical billing and coding in your office and suffering through numerous errors, which result in rejected claims that must be resubmitted, you need to correct certain practices.
Medical coding and billing errors can delay payments, result in audits, and negate reimbursements. And although no one is perfect, it’s important that your medical insurance claims are as error-free as possible. Here’s a consideration of five reasons as to why medical coding errors occur.
Incomplete or Inaccurate SOAP Notes
A physician’s SOAP notes are the foundation for evaluation, diagnosis, and treatment of a patient. They are also important in terms of backing up and substantiating your medical insurance claims. Too often physician’s are overworked and overbooked, and their record keeping suffers. Confusion over SOAP notes can result in inaccurate billing, under-billing, and overbilling.
Changes in the Law or System
Federal and state laws govern the medical insurance industry and billing practices. Any alteration in the law can be a headache for practitioners and their medical practice staff.
Changes in the system, such as the current shift from ICD-9 to ICD-10 or the addition of new drugs to the National Drug Code Directory, can complicate matters. If you’re utilizing an in-house medical billing and coding system, you and your employees may find it difficult to keep up with all of the changes. Errors will occur if this is the case.
Basic Misunderstanding of Rules
Another common reason for medical coding mistakes is that those performing these tasks have a misunderstanding of the rules. This is often the case when medical billing is part of the medical staff’s workload, creating an environment where misunderstandings are common. Law, rules, and regulations concerning medical insurance billing are very complicated and misunderstanding of these can lead to situations that incite investigations regarding insurance fraud.
Poor Billing and Coding System
What type of medical billing and coding system do you have? Does it include premium software? Can everything be done using one dashboard? Is it as efficient as it can be? Is the data completely up-to-date? If any of your answers to these questions are “no,” then you’re going to not only have to endure a very slow process of billing and coding, but one that is rife with errors. As errors mount, lag time grows, and inefficiency becomes a part of your daily existence eventually putting your practice in financial jeopardy.
Checks and Balances
Most in-house billing and coding efforts lack a true system of checks and balances due to the fact that everything is happening within that office environment and staff members are often left completely responsible for certain duties. There is probably an office manager, but how connected are they to billing and coding? Who oversees those handling these procedures? Is there only one person in charge of this area? Without proper supervision there are bound to be mistakes.
For the healthcare professionals dealing with in-house medical billing and coding or who have outsourced the work to a company that is unable to meet professional standards, there is a solution. That is working with professionals who are knowledgeable of, experienced in, and current on all aspects of this complex and changing field.
If you require professional medical billing and coding services contact Medical Practice Management Resources, Inc., today. We have a personalized solution for you.