Inaccurate Medical Coding Can Cost You

One of the biggest ways a thriving practice loses money is through inadequate and inaccurate medical coding. Either one is a deadly mistake for your medical billing and can result in the following:

Partial payment of your medical billing claim – meaning your staff has to stop whatever they are involved in and pull the patient’s file and note whatever has been paid and then spend time discovering why the rest of the claim was not paid. Sometimes it is an accident on the carrier’s part, but many times it is due to bad coding on the physician’s side of the medical billing.

Denial of your claim is another big time waster for your staff that could have been prevented. The file will have to be pulled, documentation read through and the claim will have to be filed again and some carriers want the direct reason for denial of claim addressed when the medical billing claim is filed again.

Rejection – this is the killer. A rejection of your medical billing claim means you did the services for free until the appeal is filed and the medical billing claim (hopefully) is reversed.

Another common way that a practice loses money is through using outdated coding. Your staff may not keep up with the changes in the medical billing and coding field and using an outdated code is the same as using the incorrect coding on your medical billing. Both will result in revenue loss.

A startling statistic shows that if one fee for service medical billing opportunity is left off a medical billing claim form per day, the average loss to the practice is $15,000 per year.

If you outsourced your medical billing, you would save a lot of time chasing paper for claims, refiling, and most importantly having your medical billing double-checked to make sure all services rendered are accounted for. Your medical billing partner is trained to read your medical billing claims and ascertain if there is a logical flow of services, if a service jumps from point A to point C, your medical billing partner is trained to locate point B.

View all Articles by: Melissa Clark, CCS-P