Incorrect coding is one of the top causes of revenue loss in healthcare entities. By identifying the reasons behind erroneous coding and devising checks and balances to avoid them, it is possible to smoothen the revenue cycle of your organization.
Coding is a rather complex set of activities conducted by every healthcare entity as part of its revenue cycle. It results in the conversion of various tasks performed by physicians like diagnoses, procedures, and medical services to alphanumeric codes for billing purposes. It is not difficult to see why coding can be so complicated. Gleaning information from transcription notes, correctly deciphering lab results and using an appropriate classification system (ICD-10-CM, CPT, HCPCS Level 2) require a high level of precision and expertise. An error in assigning codes usually shows up as a payment loss as payers reject claims with wrong coding.
You can avert the most frequently committed coding mistakes by keeping in mind the following points:
1. Make sure you are using the latest codes – The inventory of codes is revised annually by the AMA. Similarly, reconfiguration of the HCPCS codes and the NCCI codes is periodic. ICD-10 is a relatively new coding system. With several coding schemes that undergo a frequent overhaul, it is imperative for coders to keep up with the latest updates.
2. Do not abbreviate codes – To ascertain that the payer does not reject your claims, it is vital to code specifically. For example, an ICD-10 code has a provision for seven positions in all. It is essential to use the 6th and the 7th position when required to avoid payer rejection.
3. Decipher chart notes correctly – Extracting information from medical charts is a tough job. It is crucial to read the chart fully and thoroughly to conclude what codes are to be assigned.
4. Identify the patients as new or recognized – It is possible for codes to differ based on the type of patient. The evaluation and management codes are often different for a brand new patient versus an established patient. It is therefore wise to figure out the patient type before beginning the coding process.
5. Avoid upcoding – Misinterpreting charts and applying codes that stand for more complicated procedures than the actual ones is known as upcoding. Rejection of such claims is generally high. Analyzing a chart and clarifying any doubts that you may have by talking to the responsible physicians can help skirt such errors.
Reimbursement problems tend to gobble a large chunk of revenue generated by an establishment. Plug the coding-related holes in your revenue cycle by collaborating with Mirra Healthcare, a company that employs a posse of qualified and experienced medical coders.