Being an accurate and efficient medical coder is one of the most important jobs within a medical practice. Medical coders are responsible for documenting services and diagnoses correctly, so that insurance companies and providers get paid, as well as patients receiving the correct bill for services rendered. Even a small, simple medical coding errors can result in the loss of thousands of dollars for a doctor and/or lead to very unhappy patients.
Even though most medical coding errors can be corrected, if they are not caught early, they will cause a huge mess for everyone in the practice. A single error can disrupt the entire system, consequently affecting anyone involved including the patient, healthcare provider, insurance company, or government agency. This includes denial of claims, which in turn means no reimbursement from the insurance company and unhappy patients who will demand an explanation. When this occurs, the medical coder will have to go back and investigate why the claim was denied and where the error occurred. The extra time spent fixing the errors can result in a decrease in revenue, and directly affect a healthcare provider’s finances.
Provider Finances and Claims
Medical coding errors can also cause many other problems, including the wrong provider being reimbursed by a government agency or insurance company due to a coding mistake. Consequently, the wrong information could end up being reported to the IRS. This type of “miscommunication” could make a bad situation worse and be expensive, challenging, and take up a lot of the healthcare provider’s time.
In addition, medical coding mistakes also cause the underpayment of medical claims and negatively affects any healthcare provider’s medical practice. Multiple coding errors will lead to inflated medical claims and cause financial aftermath from government agencies who regulate medical practices’ claims.
Coding for Hospitals
Coders are medical professionals and are wanted by hospitals with the goal of coding accurately. Hospitals use a lot of resources for documentation programming and have coding employees working with healthcare providers to help them understand issues with patient documentation as it relates to medical coding.With hospitals being audited more often than small medical practices, it is vital for everyone to know how to document appropriately so that the treatment given is the same treatment that is documented. Incorrectly reported procedures or other treatments could cause a reimbursement differentiation of thousands of dollars.
So How Does This Affect Patients?
Medical coding errors cost patients their hard-earned money. If a patient receives an incorrect bill, it could set them back financially or result in nonpayment. Instead of paying the correct amount for a service performed, the patient could end up paying a large, or inflated, sum due to the medical coding error. The majority of these errors occur when the wrong codes are attached to the patient’s invoice. So, instead of paying for a simple procedure, the patient could end up paying a higher bill for a more complex procedure that was never done. Charging a patient for a procedure that was never done has its own set of possible consequences.
The Best Ways to Combat Medical Coding Errors
Overall, medical coding errors cannot be avoided 100% of the time. However, if the practice chooses medical billing and coders who are highly trained and have experience, the chances of errors will go down. Another great way to combat medical coding errors is to stay up to date on training for coding staff and new software for the coding department of the healthcare practice. Be sure to have coding software that helps the staff maintain their efficiency along with keeping patient information safe with substantial security settings.