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How Accurate Medical Coding Speeds Reimbursement

November 7, 2017


coding_checklist.jpgManaging the medical billing and coding for your practice may seem like a thankless job, but the importance of accuracy to the entire revenue cycle cannot be overstated. Incorrect coding is often responsible for the greatest lost revenue in a practice, causing certain claims to be completely denied and others to be only partially paid. Following up to ensure that claims are fully paid and any errors corrected takes time and a very detailed mind. Medical billing codes change on a regular basis, adding complexity to the overall process. Here’s how accurate coding can speed your insurance reimbursements and improve your revenue cycle. 

Revenue Drivers for Your Practice

There are a variety of factors that directly influence the level of revenue enjoyed by your practice: provider productivity, volume of patients, the fees paid for services, insurance claim reimbursements, patient deductibles and ultimately collections. When any of these factors are out of balance or slow, your overall revenue begins to decline. Back office tasks take up a great deal of time and generate little real income, making them a prime task for outsourcing or other methods of optimization. The goal with all office activities is to be paid the full amount that is owed to you as quickly as possible, with the fewest possible touch points. 

Incorrect Coding Costs Rise

When medical coding is not accurate, insurance claims are not paid or are only partially paid, resulting in slow payments coming into your practice. Coding and documentation are more complex than ever, making it that much more likely that there are errors. Having a computer-based system for billing and coding definitely helps. If your coding is inaccurate, you may be losing upwards of 10 percent of your overall practice revenue — a staggering number for most providers to absorb. While human errors by physicians and medical billers are near impossible to remove from the process completely, it is possible to strictly limit the number of errors through the correct use of tools. 

Rejected v. Denied Claims

There are a variety of actions that can occur when you submit a claim to a payer: the claim can be accepted, denied or rejected either completely or partially. Denied claims are claims that the payer has vetted through the patient’s insurance and determined that they do not meet the insurance requirements for payment. While these can be re-submitted for appeal, denied claims often come about due to a mismatch between the course of treatment and the insurance coverage. Rejected claims are much more common and are generally the result of a clerical or other error in the claim. Before the claim is fully processed through the payer’s systems, it can be returned to the biller for correction. This may happen in up to 30 percent of the claims that come from any medical office, making it a very time-intensive and expensive process to research, correct, and resubmit each claim. 

Related Article:  3 Medical Coding Mistakes That Providers Must Avoid.

Accurate Coding Adds Velocity

When your coding is accurate, payers consider that a “clean” claim, or one that has minimal to no defects and can easily work through the insurance systems for rapid payment. These claims share some common traits:

  • Patient information that is accurate and up-to-date
  • Provider details that match the information on record
  • Correct insurance policy number and details
  • Valid medical billing codes 

While it may seem simple to ensure a high level of accuracy for this data within your practice, the sheer volume of coding required can be overwhelming for a small staff. Even if all of this information is correct, it’s still possible that claims will be returned to the office for undercoding such as not listing particular procedures that are found during a routine audit or poor documentation. 

When you work with a professional medical billing and coding organization such as M-Scribe, you can be assured that your medical coding is completed to the highest standards of quality to provide you with a strong revenue stream. Download our free white paper today to determine which medical billing option is best for your practice, or give our certified coding professionals a call at 770-666-0470. 


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