Common Coding Errors Resulting in Improper Payments

The healthcare industry and especially the healthcare providers rely heavily on medical coding professionals who give alpha-numeric codes to the ailments, treatments, and procedures performed on the patients. These codes play a significant role in the later process of medical billing that deals with the billing of the procedures performed on the patients and is crucial to receive payments for those services. The coding professionals who are in the medical coding jobs have a gigantic responsibility of maintaining the highest levels of accuracy while coding the procedures since this process determines the reimbursements from the insurance providers. However alert and attentive the medical coders are, there will be a little scope for errors as it is natural for humans to err.

Per the U.S. Department of Health and Human Services data for 2017, the accuracy rate for proper payments is 90.5 % and the improper payment rate is 9.5 %. The common reasons for the improper payments are – a) no documentation; b) incorrect coding; c) medical necessity; d) insufficient documentation. Among all these reasons, incorrect coding accounts for about 13% and it is helpful if medical coding companies educate their medical coders about these and take the required measures to avoid such errors. Mentioned here are few common medical coding errors that are seen in the physician practices.

Hospital visit-initial: The services of hospital visit-initial account for 1.6% of overall improper payments with 19.4% improper payment rate.

Office visits-established: These services codes account for 1.5% of overall improper payments with 3.7% improper payment rate.

Hospital visit-subsequent: These services codes account for 1.1% of overall improper payments with 7.1% improper payment rate.

Office visits-new: These services codes account for 1.0% of overall improper payments with 13.4% improper payment rate.

Emergency room visit: These services codes account for 0.7% of overall improper payments with 10.6% improper payment rate.

Nursing home visit- These services codes account for 0.5% of overall improper payments with 9.1% improper payment rate.

Hospital visit-critical care: These services codes account for .4% of overall improper payments with 13.5% improper payment rate.

These are some of the services with incorrect coding errors per the 2017 Fee-for-Service Supplemental Improper Payment Data report. Medical coding companies should take appropriate measures to control the occurrence of such errors to avoid any kind of improper payments and refund of those payments with additional fees as a result of such payments.