Medical Coding is the process of transforming descriptions of medical diagnosis and procedures into universal medical code numbers. The diagnoses and procedures are usually taken from a variety of sources within the healthcare record, such as the transcription of the physician's notes, laboratory results, and other sources.
Medical
coders are responsible for the accurate reimbursement of payments from
insurance companies to hospitals and other service providers. This means having proficiency in medical terminology
and health related topics. It also
requires the coder to be extremely accurate and conscious to minutest details.
Medical billing professionals, on the other hand, act as a link between health
insurance companies and healthcare facilities. They prepare and present
insurance claims.
The
profession of medical coding and billing comes tagged immense responsibility as
even a slightest error can prove to be very grave and costly both for the
patient and the doctor. Errors in medical billing could translate to heavy
bills for if the treatment is coded wrongly into a code that does not cover the
insurance.
Let us now see some of the common medical
coding and medical billing errors, so as to quick scan your report.
Error of Up-coding:
Sometimes a medical billing code of a
higher severity is incorrectly applied to a trivial diagnosis or treatment. This
can mean huge inflated bills for a treatment of much less value. It may be noted that the Error of Up-coding is
against the law.
Two classic
examples of this type of error are:
·
Coding the name of medicine into the
branded medication category, when the medication distributed was general.
·
When the patient is wrongly coded for
inpatient care while he came for an outpatient visit.
Error of Unbundling:
In some cases charges that usually are a
part of one billing category/code are listed separately. This can make the bill
hugely expensive and full of double charges.
An example of unbundling error:
In cases where the patients are prescribed
several medical tests which should be categorized under the same head (i.e.,
bundling) are billed separately (un bundling). This obviously leads to inflated
bills and such errors can be legally framed.
Error
of Duplicate Billing:
This is one of the most common billing
mistakes that inflate the patient’s bill. What this means is, a patient is
billed multiple times for the same service. This error typically occurs when
both the Doctor and Nurse instruct the billing department that the patient
needs to be billed thus duplication the bill and the amount.
For instance, sometimes patients are charged
many “first days” in the hospital, which definitely cost more than what should
ideally be charged. This is unfortunately a very common billing mistake that
elevates patients’ bills.
Error of Balance Billing:
This kind of error occurs when the
patient has an insurance claim and is incorrectly charged for leftover balance
after the claim is submitted to the insurance company by a doctor’s office or
hospital. It is imperative that the patient always checks with their insurance
company to check if all the billed charges come under the purview of their
claim and if not, what the balance amount chargeable is.
Error of Lack of Medical Necessity:
In some cases the insurance company may
not grant the coverage, citing a “lack of medical necessity.” This typically
happens when a doctor doesn’t provide correct information to the coder about
the diagnosis. In such cases a wrong
code may be applied on the bill.
Error of Incorrect Patient Information:
Insurance companies can rightfully reject
the claim if the information provided about the patient or the insurance number
is incorrect. It could be an error as small as omission of a single alphabet or
misspelling of the name. These errors unfortunately are the most common type
because many people may be handling one claim between the insurance company and
the health care facility.
The above areas are where many of the
common medical billing and coding errors occur, In our next article we will see
how to combat these!
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