Medical Codingis the process of transforming descriptions of medical diagnosis and procedures into universal medical code numbers. The diagnoses and procedures are usually taken from a variety of sources within the healthcare record, such as the transcription of the physician’s notes, laboratory results, and other sources. Medical coders are responsible for the accurate reimbursement of payments from insurance companies to hospitals and other service providers. This means having proficiency in medical terminology and health related topics. It also requires the coder to be extremely accurate and conscious to minutest details. Medical billing professionals, on the other hand, act as a link between health insurance companies and healthcare facilities. They prepare and present insurance claims.
The profession of medical coding and billing comes tagged immense responsibility as even a slightest error can prove to be very grave and costly both for the patient and the doctor. Errors in medical billing could translate to heavy bills for if the treatment is coded wrongly into a code that does not cover the insurance.
Let us now see some of the common medical coding and medical billing errors, so as to quick scan your report.
Error of Up-coding: Sometimes a medical billing code of a higher severity is incorrectly applied to a trivial diagnosis or treatment. This can mean huge inflated bills for a treatment of much less value. It may be noted that the Error of Up-coding is against the law. Two classic examples of this type of error are: ·
Coding the name of medicine into the branded medication category, when the medication distributed was general. ·
When the patient is wrongly coded for inpatient care while he came for an outpatient visit.
Error of Unbundling: In some cases charges that usually are a part of one billing category/code are listed separately. This can make the bill hugely expensive and full of double charges.
An example of unbundling error:
In cases where the patients are prescribed several medical tests which should be categorized under the same head (i.e., bundling) are billed separately (un bundling). This obviously leads to inflated bills and such errors can be legally framed.
Error of Duplicate Billing: This is one of the most common billing mistakes that inflate the patient’s bill. What this means is, a patient is billed multiple times for the same service. This error typically occurs when both the Doctor and Nurse instruct the billing department that the patient needs to be billed thus duplication the bill and the amount.
For instance, sometimes patients are charged many “first days” in the hospital, which definitely cost more than what should ideally be charged. This is unfortunately a very common billing mistake that elevates patients’ bills.
Error of Balance Billing: This kind of error occurs when the patient has an insurance claim and is incorrectly charged for leftover balance after the claim is submitted to the insurance company by a doctor’s office or hospital. It is imperative that the patient always checks with their insurance company to check if all the billed charges come under the purview of their claim and if not, what the balance amount chargeable is.
Error of Lack of Medical Necessity: In some cases the insurance company may not grant the coverage, citing a “lack of medical necessity.” This typically happens when a doctor doesn’t provide correct information to the coder about the diagnosis. In such cases a wrong code may be applied on the bill.
Error of Incorrect Patient Information: Insurance companies can rightfully reject the claim if the information provided about the patient or the insurance number is incorrect. It could be an error as small as omission of a single alphabet or misspelling of the name. These errors unfortunately are the most common type because many people may be handling one claim between the insurance company and the health care facility. The above areas are where many of the common medical billing and coding errors occur, In our next article we will see how to combat these!