The amount of reimbursements a healthcare facility gets depends on the accuracy of claims submitted by the medical billing team which is dependent the medical coding team’s accuracy of medical codes assigned to the various procedures performed during a patient visit. The complexity of medical coding system makes it a challenging process and however best a team works; there could be chances of coding errors that result in wrong billing and subsequent delay or denial of reimbursements for the services provided.
It has been observed that one of the biggest causes of errors by people in medical coding jobs is due to inadequate or improper medical documentation. It is from the medical documentation records that the medical coders take data and assign codes to the diagnoses and procedures performed. Apart from this, inadequately trained medical coders or lack of ongoing training to the coders is also a reason for coding errors. Medical coding companies should take appropriate measures to train their medical coders on a regular basis to update their knowledge about the various code sets used to assign codes and their relevance.
Coding errors not only lead to financial losses to the healthcare provider, but also impact patient care. The basic aim of any healthcare facility would be providing quality healthcare to its patients. But with inaccurate coding, there are chances of not achieving this and it may lead to irreparable loss to the reputation of the facility resulting in losing valuable patients. Let us see how coding errors can affect the healthcare facility and patient care.
- Patient Care: Inaccurate coding can directly affect a patient’s care. When a patient diagnosis is wrongly coded, it may not affect immediately but, at a later stage when the patient visits a physician, his/her medical history shown is wrong in the records due to the wrong diagnosis code used previously. This results in improper patient care.
- Reimbursement Problems: Services provided by a healthcare facility turn into billable revenue only after the services are assigned appropriate codes and these codes are correctly reflected in the medical bills. Failure on the part of the medical coders to assign the appropriate codes can cause errors in billing too resulting in delayed, partial or denied reimbursements from the insurance companies. The denied claims need to be resubmitted to the insurance provider after correcting the claims.
- Fraud and Abuse Fines: People in medical coding jobs need to be really careful while assigning codes because facilities that have a history of coding errors can be levied fines or penalties by the federal authorities on the charges of abuse or fraud.
Healthcare facilities should monitor their coding and billing processes regularly and train their employees with the latest updates in coding field to ensure that they do not face issues with medical coding errors and avoid the negative impact of these errors. As a proactive measure, healthcare facilities can outsource their coding and billing processes to medical coding companies that have experienced staff with expertise in assigning the right code for service.