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Hospital Medical Billing and Coding; How to Improve Your Processes

November 3, 2022

The success of your hospital largely depends on an efficient billing process. Without having an experienced biller on board, it is increasingly difficult to minimize errors, adhere to new regulations, and optimize the billing system. These challenges will only lead to an obstruction in your cash flow or worse, not getting paid.

Below are strategies you can use to help improve your billing workflow and help your hospital maintain financial independence.

Common Mistakes to Avoid in Hospital Medical Billing and Coding

Your hospital staff may be so focused on delivering top-notch patient care that they may overlook errors in the billing process. Unfortunately, failure to follow hospital medical billing guidelines may negatively affect your bottom line.

These are the most common hospital medical billing and coding errors you must avoid:

  • Duplicate hospital billing – This happens when you bill a patient at least twice for the same test, exam, procedure, or treatment. It is typically the result of a staff member failing to determine whether the patient has already paid for the service. This can lead to additional administrative work for both your staff and payer. 
  • Incorrect billing/Coding errors – This occurs when you bill a patient for incorrect services or for those they never received. Wrongful billing also means billing a patient for a service that was scheduled and then later canceled. Even simple errors such as incorrect patient information or contact information for the provider, as well as incorrect, mismatched, or missing codes (incorrect modifiers) can result in denied claims.
  • Unbundling – There are hospital medical billing codes that are designed to be used for a group of procedures frequently performed together. When these services are billed under separate codes, it is known as unbundling, which is an illegal practice because it can inflate the profits for your hospital. 
  • Upcoding and Undercoding – Upcoding occurs when you submit codes for more serious and expensive diagnoses or procedures than what you diagnosed or performed. This illegally inflates your revenue by demanding higher payments than you should receive. Undercoding, on the other hand, happens when you leave off a medical billing code for less expensive procedures in the hopes of avoiding an audit or saving money for a patient. Although it can occur due to simple oversight, it can appear suspicious and result in serious consequences for your hospital. 

Verify Hospital Coding Accuracy With Audits and Reviews

While billing software and other medical technologies help streamline the coding process, audits and reviews are still an integral aspect of a comprehensive coding improvement strategy. 

Coding audits can be retrospective, which reviews submitted claims, or prospective, which analyzes prebilled claims. They can also be random or a mix of both. Whichever the approach, a coding audit includes internal or external reviews of medical coding and billing accuracy, procedures and policies in place, and other components that affect the documentation process of medical records. 

Hospital coding audits allow you to catch potential compliance errors that could result in future liabilities. These compliance-related issues can also impact your revenue, your hospital’s reputation, and the quality of care you deliver to your patients.

It is critical that audit results are analyzed, so you can prepare for proper education and training, then initiate performance improvement strategies when necessary.

Use Technology to Your Advantage – EHR Systems, Automated Claims Submission, Etc.

coronis health hospital worker consulting patient

By automating repetitive tasks like individual claims filing, payment reminders, and coding updates, you can create a more efficient billing process 

Electronic Health Records (EHR) and Automated Claims Submission systems eliminate the traditional paper-heavy process of filing claims while improving the quality and accuracy of medical coding. 

Other technologies, like Computer-Assisted Coding (CAC) solutions, can also analyze healthcare documents by identifying the appropriate medical codes for clinical documentation. 

All these technologies accelerate the medical coding process and liberate your staff from billing tasks while allowing them to focus on better patient care. 

Stay Up-To-Date on Hospital Coding Changes and Regulations

Coding is a key component of the healthcare revenue cycle. By using standardized codes and guidelines to translate medical documentation, coders will help support your hospital’s quality compliance. Compliant coding will help streamline your workflow, reduce claim denials, and ensure adherence to governmental regulations.

The healthcare landscape, including medical coding in hospitals, however, changes at a rapid pace. 

From payer rules and billing codes to fee schedules and other compliance requirements, staying abreast of changing protocols requires a dedicated team of experts who can remain up-to-date on new regulations as frequently as they are made and implemented. 

Having a team focused on billing ensures submissions are as clean and accurate as possible while allowing your billing process to stay compliant at all times.

Outsource Your Hospital Medical Billing Services

Without the assistance of professional hospital medical billers, you might be missing out on valuable income. By hiring the services of a medical billing company, you are investing in your hospital. 

Medical billing professionals have years of experience and are specifically trained to understand the medical billing process. As a result, they can navigate various issues that may arise during the medical billing process. 

Medical billing professionals are also up-to-date on the current medical codes to use when filing claims. They can make billing quick, efficient, organized, and accurate. Since they focus all their time and energy on managing your billing, you can focus on providing quality patient care.

At Coronis Health, we offer a personal, high-touch service. We have brought together the most innovative and thought-advancing leaders in medical billing and revenue cycle management to progress this industry into the modern, technological age. 

We know the challenges of juggling high-quality patient care with the business of running a profitable hospital. We’re a valuable resource with decades of experience that provides you with dedicated collection and claims processing, among other services, to help you get paid – quickly and easily.

Contact us today to learn more about our medical billing services and request a free financial checkup.

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