With the first year of full Obamacare implementation nearing its end, doctor’s offices and healthcare facilities are still working on streamlining all of the new administrative and regulatory rules and requirements that the law imposes. While medical coding mistakes are nothing new, now it is even more important to prevent them from occurring, since the administrative delays and insurance company hold-ups they cause can have even more of a significant impact. Although there are plenty of possible medical coding and billing mistakes, the following are a few of the most common and most important to avoid.
Illegible handwritten claim forms
It might seem unbelievable in today’s age of technology and computers, but there are still numerous medical coding mistakes that occur simply because they are handwritten in such a way that they are misread and mis-entered into the system. One of the best ways to avoid this is to simply ensure that all medical coding and billing is done using a computer and a printer. With more than adequate printers available for less than $100, there is simply no reason for any medical facility, no matter how small, to still be using any handwritten forms.
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Failing to add necessary modifiers
Modifiers are more important today, with the implementation of the Affordable Care Act (also known as Obamacare) than ever before. Failing to add necessary modifiers will often lead to delays in payment, and can sometimes even lead to an outright refusal for payment to be made. While there are many important modifiers to keep in mind, one of the most important times to use one is when a healthcare facility performed multiple services in a single patient visit. Modifier 25 is used specifically for this situation, as it helps differentiate a “significant, separately identifiable evaluation…service by the same physician…or other service.” Failing toutilize Modifier 25 can lead to significant delays in payment by insurance companies, and administrative staff in a medical facility should always make sure they are checking for cases in which Modifier 25 is applicable. Linking medical necessity codes to treatment codes Insurance companies have long been sticklers about having a documented medical need anytime a procedure is performed. One of the ways that insurance companies attempt to get out of reimbursing a medical facility for services rendered is by claiming that the procedure was not properly linked to a medical need. It is more important than ever before for doctors to properly document their patients’ medical issues, so that when treatments are performed, they can easily be linked to without any hassles from the insurance company. One of the other important considerations is making the diagnosis codes are specific as possible. For example, hypertension is coded as 401, but that coding will almost always result in a claim denial by an insurance company. It is absolutely imperative that any and all diagnosis codes include the maximum number of code specifics. In the case of hypertension, this involves adding a period and an addition number. Malignant hypertension, for example, is coded as 401.0, while benign essential hypertension would be coded as 401.1. It is important to specify these differences not only to avoid hassles with insurance companies, but also to ensure that the proper treatments are given to the patient. While many medical administrative staff members are familiar with the importance of properly coding claims, it is always worth spending sometime refreshing one’s knowledge so that as few mistakes as possible are made. This will save everyone involved time, frustration, and unnecessary hassle.
Accurate medical coding is a critical component of any medical practice, and is at the heart of the practice billing process. Without proper coding, a practice can lose considerable amounts of money and may even face fines and penalties when codes are repeatedly used incorrectly.