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How To Avoid Incorrect Medical Coding_ A Complete Guide?

Are you struggling with a situation when you have increased patient flow across your clinic but you collect the same or even less revenue than the potential market? Then you should think about outsourcing medical billing services to experienced medical billing companies.

Now you might be thinking how it would solve your problems?

In this article, i have provided a quick guide for those healthcare practitioners who are struggling with medical coding issues. So in order to get comprehensive insights into better decision-making_ read this article thoroughly.

But before landing right on the solution, let’s first understand what is the actual reason for the problem and how to identify it.

The major issue that holds insurance payers back from reimbursing your claims is “incorrect medical coding”.

Impact on Net Revenue:

It is inevitable that every piece of information mentioned in your medical claims must be 100% accurate. A single error in documentation, a spelling mistake, outdated medical codes, irrelevant and wrong medical codes_ these all factors can lead to claim denials and rejections.

In fact, it can also lead you to face federal penalties and payer’s fines. That would not only hit your business’ financial growth but your reputation as well. These circumstances usually put medical care providers under strict scrutiny for fraudulent and abusive billing practices.

Especially, when administrative staff starts to practice illegal activities i.e. Upcoding or under coding to get extra money from your patients. As a result, it also causes disputes in the patient-provider relationship.

Ultimately, it reduces the factor of trust among you and your patients and shrinks your customer-base ultimately. Conclusively, a simple error in medical coding can damage your healthcare revenue cycle management to a great extent.

Now, you’ve got a clear idea about how incorrect medical codes reduce cash flow for your practice. But have you ever wondered which factors contribute to incorrect medical coding?

Here are the top 8 factors that cause errors in medical coding and tips to avoid them;

#1 Incorrect Documentation:

Accurate documentation is the foundation of an efficient and profitable revenue cycle management system. Similarly, erroneous and incorrect data leads medical coders to use an incorrect set of modifiers and codes that are somehow conventionally accurate.

Although, they are conventionally suitable according to the information captured by the front desk staff. But the fact is if the information is inappropriate then it would definitely cause unwanted errors.

Therefore, practitioners should adopt the right solutions for medical billing services. Hence, they shouldn’t rely upon old and inefficient systems that are unable to collect accurate information and closely monitor real-time changes in it.

So most modern healthcare facilities prefer to outsource medical billing services to experienced medical billing companies. In this way, they can get assistance from professional medical billing specialists who abide by all the standards of charge capturing.

Thus, they help you avoid sloppy documentation and assign the right codes to factually accurate information.  In such a case, it prevents your medical billing system from errors, upcoding and under coding collectively.

#2 Bundling Altogether:

With the advent of the icd-10 coding system, it has become necessarily important for medical coders to prepare claims by using a highly specific set of modifiers and codes.

Therefore, healthcare providers should only prefer certified medical coders who have in-depth knowledge of up-to-date medical coding systems. They must have proficient expertise to separate linked procedures with highly specific medical codes.

Especially, medical coders should be careful while preparing claims for linked procedures. They should “unbundle” all the procedures that could be represented by a single code.

Now here comes the pain-point for healthcare providers_ when they have to hire highly paid certified medical coders. Certainly, it thrusts upon a lot of financial burden on medical providers.

But don’t worry! Every problem comes with a solution. Hence, the best solution that physicians can adopt is to outsource their medical billing services to experienced medical billing companies.

Because a medical billing agency just charges a fixed fraction from the revenue they collect on your behalf. So they solve all your revenue related problems at a small fraction of your existing it expenditures.

#3 Billing Malpractice:

We’ve already discussed the negative impact of abusive medical billing practices i.e. Upcoding and under coding. But let’s just dive into the details of these terms here;


When the medical coding team uses a medical code of more expensive medical treatment than the actual procedure in order to fraudulently collect more money then it is called “upcoding”.

It also involves the cost of equipment that is used for diagnostic purposes by the physicians. In this way, by adding up irrelevant expenses medical billers demand higher payments. As a result, they can illegally inflate your overall revenue collection.

Under Coding:

When the medical biller or coder skips a piece of particular information about the patient’s visit and does not demand their charges then it leads to “under coding”. Although, this practice facilitates patients to pay less for their bills than their actual bills.

However, some fraudulent medical billers prefer this practice to avoid audits for the emergency departments. But it can cost medical providers their em group money.

Once, clearinghouses, legislative bodies and insurance payers recognize both such practices in your revenue cycle management then they definitely penalize your practice.

Therefore, successful healthcare practitioners do not rely on unqualified medical billers and coders and they prefer to outsource their medical billing services to experienced medical billing companies.

In this way, they get access to professional assistance and guidance. It helps them to keep their business safe from revenue loss due to these loopholes.

Have you decided to scale up your healthcare organization to safe levels? Medcare mso is the most trusted medical billing company in the united states. We have been helping thousands of practitioners to practice well-managed medical billing and coding for more than 12 years.

Peter Christopher

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