Medical coding allows insurance companies to determine whether certain procedures should be reimbursed, reduced or outright denied. As such, it’s extremely important that medical practices don’t make any errors in their medical coding.
Accurate medical coding is necessary if you expect to obtain insurance reimbursement. It’s also important to maintaining the records of your patients. Using the wrong medical coding could result in the claim being denied even though the actual service provided to the patient should have been covered by their insurance. When this happens, your practice will lose money since you won’t be fully paid for the services you provided. When you aren’t paid as much as you should have been as a result of an error in medical coding, it’s known as under coding.
There are other potential problems that you can run into as a result of errors in medical coding as well. For example, over coding can cause serious problems. Over coding happens when you report medical codes that actually result in a higher payment being made by the insurance company. This could be considered fraud, which, in turn, could result in both legal and financial penalties.
Medical coding can get quite complicated, which is why it’s important that whoever’s in charge of filing claims to the insurance companies knows what they are doing. For example, Diagnosis Related Groups (DRG’s) are a combination of diagnosis, procedures, complications, symptoms, pre-existing conditions, and age and gender. These are some of the most complicated medical codes.
Not only do you need to make sure that the proper codes are used for the services you provide to your patients, but you need to stay up to date with changes made to medical codes, which occur on a yearly basis.
Leaving your staff in charge of medical coding is not always the best idea, especially if they have other responsibilities within your practice. It can be difficult for them to keep up to date with coding changes. Those who have other responsibilities may be more likely to make errors as well because of the fact that they are juggling numerous tasks. By outsourcing your medical coding, you’ll greatly reduce the occurrence of both under-coding and over-coding.
ProMD Practice Management is happy to help with your billing assessment needs so you can maximize profits and increase patient satisfaction. To learn more about how ProMD can make your practice run like a well-oiled machine, call 888-622-7498 or fill out our online form to request a billing assessment.