Imagine losing thousands of dollars because of simple billing mistakes. 

In the U.S., hospitals and clinics lose an estimated $262 billion annually due to claim denials or underpayments, according to Billing Simplified. 

But you can avoid these costly errors. Want to know how? Let’s explore 10 ways to improve accuracy in medical coding and billing.

1. Verify Covered Services

One common mistake is billing for a service that insurance won’t cover. Always check if the service is covered before providing it. If you are unsure, consult the Medicare Benefit Policy Manual.

2. Double-Check Patient and Insurance Information

Errors like wrong patient or insurance details can cause denials. It is easier to make these errors, particularly when the claim is being handled by multiple people. So, before submission, double-check names and insurance IDs.

3. Billing Twice

Billing the same service twice is one of the major problems. It happens when two providers try to get paid for the same service. Always make sure that the service hasn’t already been billed. Repeating errors may lead to penalties or charges of fraud.

4. Avoid Incorrectly Unbundling Services

Unbundling happens when separate charges are listed for services that should be grouped under one code. It is considered fraudulent if it is done to get higher payments. Always check coding rules to make sure you are billing correctly.

5. Up-Coding

Up-coding is when a more severe diagnosis is coded to get higher reimbursement. It is illegal. It could lead to serious legal consequences. Always make sure you are using the right code for the service.

6. Don’t Underestimate the Importance of Correct Coding

Under-coding happens when you fail to report all services provided. This can cause lost revenue and problems down the road. It is important to code everything correctly to avoid denials and audits.

7. Lack of Documentation

The coder can’t code properly if enough details are not in the documentation. It can lead to claims being denied because of “lack of medical necessity.” You should communicate with the doctor if you feel the documentation doesn’t support the billed service.

8. Use Modifier 22 Sparingly

Modifier 22 is used for certain surgical procedures but not for general services. Some providers misuse it to get higher reimbursements. Be sure your documentation supports the use of this modifier, or you might face payer scrutiny.

9. Stay Updated

Coding systems are updated regularly. If you are using old codes, your claim could be rejected. Always check for the latest updates to avoid using incorrect codes.

10. Confirm Coverage Start Date

Billing for services provided before the insurance starts coverage will always be denied. Always verify the patient’s coverage start date to avoid wasting time on claims that won’t get paid.

Key Metrics to Improve Your Medical Billing and Coding

Net Collection Rate

Your net collection rate shows how much money you are owed actually gets collected. A strong rate means your billing process is effective. If your rate is low, you may have unpaid claims or patient balances that need attention.

How Long It Takes to Get Paid

It tracks how long it takes to receive payment after a patient visit. Delays can indicate slow claims processing or payer issues. If claims remain unpaid for over 60 days, you should investigate and take action.

Per-Visit Revenue

Tracking collections per visit helps you understand which services bring in the most revenue. Comparing monthly data allows you to adjust scheduling and resources for maximum profitability.

Are You Being Paid the Right Amount?

Insurance companies don’t always pay the agreed amount. Reviewing payment variances helps ensure you’re being reimbursed correctly. If there are discrepancies, it could mean claim denials or payment errors that need to be addressed.

Denial Management

Denied claims slow down payments. A strong denial management process helps recover lost revenue and reduces future mistakes. Regular reviews of denial reasons can highlight patterns that need fixing.

Reviewing Performance Over Time

Daily and monthly reports offer insight, but a year-end review gives a complete picture of your financial performance. Reviewing key metrics annually helps identify gaps and improve billing efficiency.

Tracking these metrics regularly improves cash flow, reduces claim denials, and increases overall efficiency. A data-driven approach leads to better financial outcomes for your practice.

Conclusion:

Inaccurate billing can lead to costly errors. But by avoiding common errors, you can improve accuracy. 

Don’t let small mistakes cost you big. Stay focused and always review your work before submitting it. 

Reach out to us today to schedule your free consultation and let our certified professionals handle your medical billing and coding needs! 

FAQs

Why is communication necessary for improving medical coding accuracy?

Clear communication is essential for accurate medical coding. When coders and clinicians discuss audit results and compliance updates, they stay aligned. It makes sure that documentation is thorough and accurate.

Why should practices consider outsourcing medical coding?

Outsourcing medical coding can offer several benefits. It allows practices to tap into skilled coders without the need to hire or train new staff. It improves coding accuracy, ensures compliance with regulations, and optimizes revenue. Outsourcing also saves time and resources, which allows your practices to focus on patient care.

How do medical coders stay up-to-date with changes in coding?

Medical coders regularly participate in training and review updates from industry authorities.

How often should we audit medical coding practices?

Regular audits at least quarterly. It ensures that coding remains accurate and compliant with regulations.

Is it better to hire in-house coders or outsource?

Outsourcing often provides more flexibility, reduces overhead, and gives access to experts.