According to research done by the Office of the Inspector General, did you know that over 40% of the Medicare E/M services lacked proper coding? The errors in medical coding and billing services could cost your company more than just losses in revenue. Medicare paid nearly USD 7 Billion for incorrect coding of claims. These situations can backfire at a later point of time when CMS identifies organizations for false billing charges. You can control these inappropriate situations by performing regular medical coding audits at your organization.

Audits are highly beneficial for the medical organization as they can highlight the issues costing the health system’s finance. They also help you to take appropriate actions at the right time to keep you away from coding and billing legal hassles. However, very few organizations focus on auditing, given the sheer volume of patient accounts and the significant number of claims filed every day. Here are some top reasons why you need to audit medical coding and billing services at your organization.

1.Audits help to identify recurrent coding errors:

  • All medical organizations need efficient coders under their wing to adequately capture the services code and maintain the revenue flow.
  • However, in some cases, administrative burden affects the quality of in-house coding services and leads to recurrent coding errors, which are not always identified.
  • Auditsget an in-depth analysis of the coding patterns that are going wrong. They can separate a one-time error from a recurring one.
  • The most common type of recurrent errors identified by the medical audits is related to a lack of updated codes.
  • Coders are often unaware of the latest modifications in the coding guidelines and use redundant codes in their claims.
  • Replacing these areas of improvement in your medical coding and billing services could improve the cash flow of the organization to a great extent.

2.Rectify modifier usage:

  • Using the correct modifier in the coding chart of the claim is exceptionally crucial for the claims to get accepted by the insurance company.
  • But unfortunately, many coding teams do not realize the importance of modifiers and tend to use them incorrectly.
  • For example, in a situation where a specific complexity of the patient has altered the procedure mentioned, there must be a modifier supporting the parent procedure.
  • However, the complexity which led you to use the modifier must be clearly supported through the detailed medical documentation.
  • In other cases, the revenue falls short for the organization since the coding team fails to use the modifier completely in the coding file.

3.Increase your revenue flow:

  • If you are experiencing a decline in your organization’s revenue flow but cannot pinpoint a reason, performing an audit might help you look at the problems in a more systematic manner.
  • Audits of various medical coding departments have revealed that organizations lose out on revenue due to issues with under coding, unbundling habits, and lack of documentation.
  • Medical claims need proper supporting documents to verify that the procedure was performed in the first place. It also highlights the medical urgency of the services rendered.
  • But without the correct codes and the complete documentation, you will not be able to realize the full amount that you are due.
  • In some other cases, the payments might get too delayed,leading to aged AR, with the insurance company asking for specific papers to support your services.

4.Avoid legal battles of medical coding and billing services:

  • In case the insurance company identifies an account where they have paid the provider more than the actual amount due to coding errors, they will come back at you with a legal notice to get the excess amount back.
  • The matter might get more complicated if they suspect any malicious behavior on your part and accuse the organization of upcoding activities.
  • Insurance panels, whether Government or private, will flag your organization for overpayment due to coding inaccuracy, which you will have to pay back.

HHS flags health systems for incorrect billing this year. Read the story here.

  • You might also get a visit from the zone program integrity contractors,recovery audit contractors, or any other governmental investigational auditors to look into the case.
  • Performing frequent audits of your medical coding on your own will save you financial and reputational loss due to legal battles.

5.Evaluate your assisting technology in medical coding and billing services:

  • Several medical organizations use the medical claim scrubbing software to get rid of any errors that might disrupt their revenue flow.
  • However, it is advisable to evaluate the technology used in your organization frequently to know if it is actually doing its job well.
  • Automation technology helps to eliminate manual errors to a great extent. But you should also look into the matter that the software is updated accordingly.
  • Audits will also evaluate your claim scrubbing software and provide you with a detailed analysis of what you can do further to maintain a higher standard.
  • Updating your software will alleviate your coding errors further and improve the quality of your claims, thereby improving the revenue cycle management.

How can you improve your medical coding and billing services?

Audits will capture the gaps in the revenue management of your company in detail. But you need to take the right steps to rectify them properly.

  • Get in touch with a leading revenue cycle management company and get your financial health evaluated.
  • Discuss your unique organizational goals with the experts and know what they can do to help you with the same.
  • RCM companies can help you in managing your goals and provide you with dedicated coding teams to handle your claims.
  • They provide end-to-end revenue management services and also tailor-made plans to achieve your goals within a short period.

We hope this blog helped you look into the compelling reasons why you need to audit your medical coding and billing services. If you have any queries, please drop a comment below. For more such articles on healthcare billing, management, and technology, please subscribe to our blog. Follow us on LinkedIn, Twitter, Facebook, and Instagram for regular updates.