Reimbursements for medical bills depend largely on the accuracy of medical coding. A lot of time is spent matching codes when processing claims. If the coding matches the diagnosis or procedure, claims are easily approved. When there are errors, it causes delays. And if the errors are glaring, it leads to denials. In this blog, we’ll go over the top coding errors that can cost you clean reimbursement.
Documentation Errors
Documentation errors can occur for a variety of reasons. These include prescribing errors, transcription errors, administrative documentation errors, etc.
Many of these errors can be managed through appropriate mechanisms. First and foremost, this includes up-to-date training for clinical staff and internal administrative staff.
Training must include knowledge of changing medical legislation, medications, unknown allergies, contraindications, an appropriate mechanism for cross-checks including protocols for prescriptions, abbreviations, medication lists, pharmacist queries, etc.
A simple way to control errors is to rely on software and other technologies. These systems can detect errors and missing fields on their own and help you reduce the error rate to near zero.
| Reasons For Documentation Errors· Incorrect interpretation of prescription drug orders· Dictation errors while keying in notes· Selecting the wrong medicine after entering the first few letters· Accidental entry of wrong medication dose like daily for weekly· Difficult the read handwriting· Incorrect use of abbreviations |
Unbundling
Unbundling” is a medical billing fraud. Sometimes, it is committed inadvertently, but is interpreted as a deliberate attempt to mislead. It involves billing multiple procedures separately, in place of one available code. As a break-up in billing helps the practice recover more money for the same procedure, it is considered as fraud.
Here’s a good example for unbundling – entering separate codes for incision and suturing for a regular surgical procedure, instead of the standard billing code. This helps the practice in extracting more money from the payer.
The practice of unbundling can invite heavy penalties. As it is sometimes committed inadvertently, practices can ensure this doesn’t happen by training employees adequately and having a fool-proof quality check mechanism in place. Every bill generated must go through a thorough quality check by experienced billers to spot issues like unbundling.
Upcoding
Upcoding is another form of fraudulent billing for medical services. In this type of billing, practices tend to submit more expensive claims than they should. This is primarily done by assigning codes that are more expensive than what was actually performed. Some examples include billing for a complex x-ray exam when a simple exam was performed, billing sedation as complex anesthesia, or billing a procedure performed by a nurse as performed by a physician.
Upcoding is fraud and is considered an attempt to defraud the system. Healthcare providers must refrain from doing this in their practice. Employees must be educated about the consequences of this misconduct. Because this type of misconduct is sometimes committed without the knowledge of physicians or administration, it is important to perform quality control to detect upcoding.
Undercoding
Undercoding is the opposite of upcoding. It is also referred to as downcoding. In this type of coding, certain documentation details are intentionally omitted. In doing so, the procedure is not specified with the desired level of specificity. Some practices do this intentionally to avoid the risk of claim denials. Sometimes this is also done to protect themselves from audits. Under the law, undercoding is a violation of medical coding principles. It is also considered an attempt to manipulate the system. One of the reasons for the change to ICD-10 was to improve the process to ensure accuracy in assigning diagnoses.
One disease that is often undercoded is diabetes. This occurs when physicians or practices simply code this disease as “diabetes without complications.” According to regulations, it is mandatory to indicate the specific type of diabetes for which treatment was provided, and the actions taken to control it must be fully documented.
As with upcoding, undercoding can also be controlled through awareness and recruitment of the right professionals. In addition, providers must use advanced tools to ensure that undercoding is detected. It is also helpful to have an internal audit team to check for upcoding and undercoding.
Duplicate Billing
Duplicate billing means trying to get paid twice over by issuing the same bill to two different payment parties. It can be like billing either Medicare/ Medicaid along with a private insurance company or the patient for the same procedure. This can also happen when two different providers send the same bill for procedure performed on the same patient and on the same date. Likewise, any attempt to charge more than once for one particular service is interpreted as duplicate billing. For instance, billing as an individual code and also as a bundled set of tests is viewed as duplicate billing.
Duplicate billing is viewed as a fraudulent attempt to get paid more than what is due. It may invite fines and affect provider reputation. The best way to avoid this is by being extra cautious and taking the billing procedure through multiple stages of quality checks.
Conclusion
Mistakes in medical billing and coding process can prove to be very costly for providers in either the short or long run. Therefore, healthcare practices need to take all possible measures to ensure cent percent accuracy in medical coding. One easy way is to outsource the task to medical coding outsourcing companies in USA or a third-party medical coding company.
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