Contact us at 888-311-8760. These issues take its toll on your overall practice outcomes, with patient care impacted and/or revenue at risk. Affects Reimbursement: Improper coding leads to improper billing, which can directly impact a clinic's bottom line. In particular, what is the responsibility of a junior partner when a coding decision is done incorrectly to enhance reimbursement? Healthcare (Basel). Using a public hospital funding model to strengthen a case for improved nutritional care in a cancer setting. Copyright 1995 - 2023 American Medical Association. You must include proper documentation to explain why the procedure requires more work than usual. Would you like email updates of new search results? According to a Department of Health and Human Services report, Medicare inappropriately paid almost $7 billion for improper coding or claims with lacking documentation in 2010[, This has resulted in the Department of Health and Human Services publishing recommendations that include the following[, Physicians being better educated on coding and documentation requirements, Erroneous claims for E/M services followed up on, Physician groups encouraged to have contractors review E/M services billed for by high-coding physicians. The most common medical billing and coding errors lead to high denial rates and may compromise patient care. The resolution of this conflict will not require refiling. 2022 Jul 4;22(1):555. doi: 10.1186/s12877-022-03241-x. Overcoding Undercoding And More Avoid These Top Medical Coding Mistakes Possible consequences of inaccurate coding and incorrect billing are denied claims/reduced payments, prison sentences, and/or fines. It centers around the concept of speaking out when you see or suspect that something is wrong. A simple slip of the fingers can result in the incorrect entry of a procedure code. The denial of an insurance claim (in regards to improper coding) is usually a result of two common types of improper coding: under coding and over coding. Inaccurate coding leads to inaccurate reimbursement, and in some cases, legal action against your practice. If incorrect charges go through in full, your practice can be hit with upwards of $10,000 in damages, plus 10 years of jail time per claim per CMS (Medicare/Medicaid) Guidelines. Medical billing is the actual processing, submitting, and following-up of claims. The most significant of the factors underlying coding error and DRG change was poor quality of documentation. When it comes to medical coding errors, they fall into the broad categories of fraud and abuse.. Loss of practice revenue. Practices should have professionals in place who are aware of the ever-changing compliance rules, and audits should be performed regularly. It takes enough time to submit the claim as is. Some common examples of inaccurate coding and incorrect billing issues that may affect your practice include: The consequences of billing and coding errors include delays in reimbursements. While miscoding can seriously impact your practices finances, it also directly impacts patient documentation. Overcoding violations refer to assigning an inaccurate billing code for a service or procedure.