Why Medical Coding Accuracy is Pivotal & How it Speeds Reimbursement?

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“Careful treatment of your medical information is intrinsic to good Health Practice.”

Healthcare professionals have a big responsibility for their patient’s health and appropriate management of their financial accounts. Medical coding plays a crucial role in the healthcare industry as it is used for medical insurance reimbursement and for maintaining patient records. 

The medical codes associated with a patient’s treatment or illness must be calculated and logged accurately in the electronic health record systems as it enables the payers to know the illness of the respective patient and the method to treat it. 

The picturization of the entire medical coding process might seem oversimplified; nevertheless, on practical grounds, it’s a stressful operational task that needs strenuous care and excellence in order to improve the financial health of service providers and the original health of the care seekers.

Reasons Why to Care for Accuracy of Medical Coding

In the need of urgent care, people usually take up an emergency medical procedure. And many times, the brief stay of the patient isn’t expected to receive an itemized bill that lists the imposed fee for an array of treatments and medications.

In this scenario, sometimes the payer ends up overpaying, and at some point the some of the miscellaneous money is blasted onto the patient to clear either all or part of the service charges. Such circumstances mostly occur due to administrative errors or inconsistencies at the end of the insurance company or due to the negligence of the staff working at the service provider’s end.

This renders a truth that “Medical Bills are often entangled with Inaccuracies” that go unnoticed and unattended.

The ignorance of minor errors while processing medical bills renders major repercussions to be suffered by the care seekers. Furthermore, these erroneous bills incur increased costs that ultimately, incur higher premiums for all of us.

Thus, registering patients, logging diagnostic codes, updating actual treatment costs, and verifying codes and the summed bill charges must be strenuously scrutinized and cross-checked at the end of providers and payers respectively. 

#To Avoid Balance Billing

Oftentimes, a patient opts for services from a provider and assumes that such services are covered under the health insurance plan taken. Change of policies in the insurance companies occurs very frequently where no one updates the changes to the insurance holder in-person detailing the modifications that occurred in their plans.

And if the insurance companies decide certain medical services aren’t covered in their updated plan or even the original plan and aren’t valid for reimbursement procedure, then the patient, ultimately, has to bear the unexpected expenses.

This Balance Billing practice is illegal in many cases; nevertheless, the unaware patients wind up paying the balance. 

#To Avoid Upcoding

Inflation in medical bills is also caused due to a small but significant reason of fraud. By this, we mean that sometimes it is seen that the providers intentionally generate incorrect bills and get accused of ‘Upcoding’ just to receive higher amounts for their rendered services.

To explain it better, let’s take up an example of ‘facility fees’ that is upsurged heavily in the name of emergency care provided to a patient. Charging on top of medication and service expenses, mostly it is seen that even the minor treatments given are coded as high-complexity visits.

The fee is generally coded on a scale of 1 to 5 that reflects the intensity of complexity in increasing order, 4-5 indicating to being critical lifesaving procedures. Upcoding is seen when given antibiotics and basic care are scaled high to 4 instead of their actual low code from bein 1 or 2.

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From a health and financial perspective, patients are the most vulnerable who have to carry the trouble both ways. Thus, accuracy in medical billing processing and examining is expected by both the ends from providers as well as insurers.

To maintain a healthy balance between the give and take relationship of medical care, providers can take a step to automate their billing process, implementing Intelligent Automation Solutions.

This will help improve accuracy in operational and coding tasks, will cut downtime taken by the resources, reduce administrative costs, and will certainly enhance productivity and financial health of the practice.

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How Accurate Medical Coding Speeds Reimbursement?


#Correct Coding Maintains the Revenue Cycle

With incorrect coding, insurance claims get stuck. They are either delayed or rejected or partly paid that proportionately results in a slower payment process for your practice. Medical billing codes frequently get changed that end up adding complexity to the overall hierarchy of the billing system.

This is where maximum possibilities of inaccurate billing codes arise that halt the end process of reimbursement and resultantly starts to decline the revenue generation. Thus, accurate medical coding helps liquify revenue streams and helps achieve the goal to be paid fully.

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#Accurate Coding Reduces Costs

Medical codes not being accurate renders the possibility of denials and resubmissions. This not only lessens the chances of early payments rather consume a lot of effort, time, and cost involved in correcting them and resending them to the payer for verification and validation checks.

On the other hand, a software system deployed at the place of a human expedites the task by outputting accurate and efficient coding results that can be cleared and reimbursed in one go. 

Automated health record systems help remove the medical billing and coding hurdles, thus saving costs and time spent on rework and resubmissions.

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#Accurate Coding Adds Velocity

Coding without errors will lead to the next accurate steps in the medical billing tasks and operations. On submission of flawless claims, payers won’t hesitate to consider them as ‘clean claims’ and will easily pass the claims through their insurance systems to process the payment at a rapid speed.

Some common features of such claims include:

  • Up-to-date and accurate patient data logged
  • Matched provider details with the records
  • Correct insurance policy number and miscellaneous details
  • Valid, updated, and correct billing codes

All these traits mentioned might seem easy to acquire within your RCM and billing procedures; however, are difficult to attain while orchestrating large volumes of coding data that overwhelms staff at one point.

Providers in this case must ensure that they integrate advanced EHR systems within their practice to avoid any possible chances of delayed reimbursement and halts in the revenue generation cycle.

Rest Assure of Accurate Medical Coding with High-Quality Standards!

Partnering with a leading outsourcing company will allow your practice to boost its revenue generation and medical billing accuracy to an exponential extent. NetSet Digital leverages the potential of Intelligent Automation and applies the best practices to assure that your medical coding is completed to the highest standards of quality, improving the financial status of medical practice.

Leave all your medical coding and billing grunt work on us to get guaranteed results for faster reimbursement using automation solutions. To get answers to your queries, get in touch with our experts.

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