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How to Avoid Medical Coding Issues

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Medical billing and coding is often so complex that errors commonly occur, even when the best policies, practices, and procedures are in place. Knowing how to avoid medical coding issues can save your healthcare organization a lot of money. This is because the most common medical coding issues, no matter how minor they may appear, can result in the denial of patient claims, a loss of revenue, fines, and penalties. Unfortunately, coding issues may even directly impact patient care. Contact Sunwave Health today online or by calling us at 561.576.6037 to learn how our electronic medical records software can help prevent medical billing and coding errors, reduce rejected claims, increase payments, and keep your patients loyal to your organization.

How to Avoid Medical Coding Issues

Some of the most common medical coding issues can be avoided with the appropriate electronic medical records software and proper training of your staff. Here are additional ways your business can learn how to avoid medical coding issues.

Ensure Patient Data Is Accurate and Complete

Claims are often rejected because of incorrect patient details. One way to know how to avoid medical coding issues is to ensure the data sets of each individual patient are not missing:

  • Names
  • Addresses
  • Date of birth
  • Age
  • Insurance information
  • Treatment periods

Incorrect patient data can be prevented by double-checking all forms and validating all pieces of information about a patient before filing a claim.

Prevent Upcoding

When a medical coder reports a service that has a larger reimbursement cost than the service that the patient had been provided, this is called upcoding. One such example of upcoding, one of the more common medical coding issues, is when a patient’s tests are conducted by technicians but are incorrectly coded as if they were done by a specialist. Reasons for upcoding can be:

  • Human error in entering treatment and diagnostic codes
  • A misinterpretation of the physician’s information

Because medical codes for certain operations and tests need greater fees, these coding issues will falsely inflate your income, resulting in denials and possibly compliance issues, fines, and penalties if caught during an audit.

Use the Most Current and Updated Medical Coding Manual

The rules for medical coding are consistently being updated and changed. It is essential that your staff use the most current medical coding manual and stay abreast of updated billing standards and regulations. By providing your staff with the most recent coding guides and requiring them to attend continuing education lessons to refresh their coding methods, your business can avoid losing income as a result of medical coding issues.

Stop Duplicate Billing

Duplicate billing is when one of your patients gets billed multiple times for the same procedure that they had just once. Not only is this one of the common medical coding issues that negatively impact your patients directly, but the error will also increase the chances of claims being rejected, resulting in a delay in your organization getting paid for the procedure.

Complete Regular Medical Records Audits

A medical records audit will examine your billing and coding procedures and policies to ensure that common medical coding issues are eliminated. One of the ways to avoid medical coding errors is through proper training and the modern electronic medical records software from Sunwave Health.

Overusing Modifier 22, Increased Procedural Services

In order to properly make use of modifier 22, Increased Procedural Services, your organization is required to include proper documentation to explain why the procedure requires more work than usual. Incorrect usage is one of the common medical coding issues resulting in claim denials.

Learn More at Sunwave Health

Sunwave Health’s electronic medical records software can help you make your staff’s jobs easier by helping them avoid medical coding issues. Learn more by calling us 561.576.6037 or reaching out online to learn how our infrastructure sets us apart to drive healthy results for healthcare providers and patients.