According to Forbes, Doctor’s waste over 2/3’s of their time doing paperwork. The paperwork bloat in the healthcare industry is a well-documented (no pun intended) phenomenon, so much so that the costs of in house administration can cause serious problems for clinics. Most patients have at some point felt their experience visiting a doctor was punctuated by deep frustration with the administrative staff—who, in turn, is also mired in tremendous amounts of paperwork. Through all of this red tape, it is more than likely that errors in billing are made quite often; here are three common medical coding mistakes that novice coders often make:
- Incomplete/Incorrect Information – The most obvious and straightforward error is that the claim is incomplete or missing information. Just like how at the start of a brand new year you keep placing the old date down and having to cross it out (seriously, March is the cut off for this, get it together). Even more common is incomplete or flat out incorrect patient information. Mistakes such as a misspelled name, a wrong date of birth or sex can all be simple and overlooked mistakes that can cause a rejection. A patient’s listed insurance must be verified and it is often the case that insurance policies are in fluctuation year to year. While patients may think they are paying for the same service if they keep—roughly, the same plan and price, unbeknownst to them, the coverage may have changed.
- Medical Coding Mistakes – CPT Codes are an efficient way to transcribe patient symptoms—that is until they get botched up. Claims can and often do get rejected for reasons outside of whether they can be paid out, one of the major reasons for this is simple mistakes resulting in a mismatched diagnosis. A rather mundane reason that can account for such mistakes is simply using old reference manuals for coding. It is often the case that new manuals have revisions, code swaps or a complete redefinition of a particular grouping of symptoms. Of course, none of this matters if your handwriting is so illegible that nobody can read your perfectly accurate transcriptions. This issue can be remedied by switching to an electronic health record.
- Accidental Upcoding or Unbundling – This one is a doozy. Upcoding is when the transcriber/coder mistakenly takes a diagnosis and “upgrades” it to something more serious. Naturally, the only thing that determines if this is illegal is the intent. Regardless, mistakes do happen and conditions are inflated thus leading to increased charges. A simple example is a hypothetical situation where a patient only met with the doctor for a routine examination or follow up and is billed for a full examination.
Unbundling is when a diagnosis that involves a cluster of procedures is billed separately at the full rate. Needless to say, this can get expensive real fast as many such procedures are billed as a package deal. If your bill comes out much higher than you expected, this is surely an obvious culprit to look for. Another simple culprit—albeit less insidious than upcoding, is duplicate billing. It’s just as it sounds; you are billed more than once for a procedure.
Outsource Your Medical Coding Needs
The medical billing landscape can be tedious and difficult to navigate landscape rife with mundane landmines that are easily tripped. An experienced medical billing support team is indispensable for cutting administrative costs and avoiding losing revenue due to simple clerical errors. A team of specialists can smooth the road between the provider and the clinic. Having a streamlined and efficient submission process is crucial for any practice big or small.
The Psych Biller has more than a decade of gained proficiency in the medical billing and coding world. Our team of dedicated professionals can help you save time and money by providing streamlined services that will help your office run more smoothly. Contact us at (800)-955-3461 today!