How Coding Analysis influences your Healthcare Organization’s Reimbursement?

 Erika Regulsky Tags: , , , , , , Coding, RCM
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Well-Organized Healthcare Reimbursements are Largely Dependent on Efficient Coding Analysis

The health of any physical practice is linked to a steady inflow of reimbursements, and what drives this inflow is accurate coding analysis. It’s that part of the revenue cycle that needs to be well lubricated in order for it to be constantly in motion. The process of reimbursement begins as soon as a patient with a health coverage policy contacts a hospital or clinical practice for the treatment of an illness.

Hereon, for the services rendered to the patient, and for the practice to get paid, the billing protocol has to be in accordance with a set of codes relevant to the disease diagnosed, procedures performed or treatment rendered. These are healthcare compliances mandated by the Department of Health and Human Services (HHS). The federal agency, Centers for Medicare and Medicaid Services (CMS) is the regulatory authority for medical coding

Any breach in the billing protocol in the form of incorrect coding can have the payer delay the reimbursement or outright deny it. So it is imperative for any health provider to know the basics of coding.

There are three different coding variants 1) Healthcare Common Procedure Coding System (HCPCS) 2) Current Procedural Terminology 3) Code Analysis and Application.

The American Medical Association has identified eight of the most common medical coding errors made by reimbursement claimants.

1. Unbundling codes, or using multiple CPT codes for parts of a procedure
2. Upcoding
3. Failing to check National Correct Coding Initiative edits when reporting multiple codes
4. Not appending the appropriate modifiers, or appending inappropriate modifiers
5. Overusing modifier 22 — increased procedural services
6. Improper reporting of time-based infusion and hydration codes
7. Improper reporting of injection codes
8. Reporting unlisted codes without documentation

Meticulous Coding:

The job of a professional coder is to be highly meticulous. In a broad sense, what this means is to extract every bit of information from medical reports provided by physicians, and taking notes of verbal communications. The coder needs to be absolutely familiar with medical terminology for both, procedures as well as diagnosis.

Inadequate Documentation:

In a few cases, the coder may not receive adequate information from physicians about procedures performed on a patient, important details on the procedure would be missing in the report. Illegible reports can also make a coder’s job difficult.

Physician Inaccessible:

It’s a good practice for a physician and coder to be easily accessible to each other, but this doesn’t usually happen. The physicians at the time become incommunicado to explain or define complex procedures to the coder, and this inexplicably has a coder use his own disposition, resulting in coding errors.

 Under & Over Coding:

Under-coding refers to filing a claim reporting a less expensive procedure than what was performed. Over Coding, is reporting an over expensive procedure than what was performed. Under-valuing or over-valuing procedures are bad billing practices, and may possibly come under state audit, or it would be reported as fraudulent claims. The American Medical Association offers a number of resources for billing services and procedures with Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding (HCPC) system codes.

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I’m a multi-certified revenue cycle management professional and compliance officer with 20+ years of experience. I contribute articles to leading healthcare publications and journals. I am currently working as Senior Transition Manager, in BillingParadise headquartered at Diamond Bar, California. BillingParadise offers Medical Billing Services that intersect perfectly with the EMR/Practice management system you use.BillingParadise has offices in New Jersey, New York, Florida, Georgia, Minnesota, and Texas.

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