Edit fatigue is real. And so is medical claims being rejected due to incorrect coding. The complexion of medical coding has changed over the years. As reimbursement mechanisms become more complex and evolve at a rapid pace- there is one constant. Medical coding is the foundation on which the entire revenue cycle lies. Incorrect codes have a cascading effect and impact various processes.

The sheer volume of medical coding and documentation guidelines can trip up the most experienced of medical coders. SolvEdge offers coding audit services for healthcare organizations of all specialties and care settings. Over the years we’ve come across several coding issues during our audits. Here is a rundown of the most common coding errors.

Unstandardized Medical Coding Process

Diversity of interpretation leads to variability in extracting information from clinical documentation and assigning codes. There can be different principles for assigning HCC, DRG, coding quality parameters etc., Inconsistent coding processes can have negative downstream effects. It affects coding quality and results in a disjointed coding workflow.

Not utilizing CAC

Computer assisted coding (CAC) tightens coding workflows. Automated CCI and LCD alerts and edits bring to the surface overlooked coding issues. Auto-suggestions of medical codes reduce time spent on assigning codes. It improves the productivity coding teams.

Incorrect Modifiers

Overusing modifiers such as modifier-22, that denotes why a medical procedure requires additional work, is a common coding mistake. It is essential to append documentation that supports the modifier to ensure claims don’t get rejected. Random usage of modifiers result in non-compliance and denials. In-depth knowledge of global surgical package and National Correct Coding Initiative (NCCI) edits is important to avoid adding incorrect modifiers.

Mismatched codes

Mismatched diagnostic and treatment codes result in reimbursement delays and claim rejections. CEU , vetted coding systems, utilization of medical coding tools can reduce code mismatches and errors to a large extent.

Infrequent Audits

Conducting periodic internal and external audits is necessary to ensure optimal efficiency of the coding process. It is imperative to perform regular audits to prevent costly mistakes that an snowball into compliance and reimbursement issues.

The Wrap

Risk management has become an integral part of the financial strategy of healthcare organizations. Erroneous codes pose operational, financial and strategic risks. Medical coding errors impede the revenue cycle and delay reimbursement.

Medical coding errors are costly mistakes. Request for a medical coding today to know where the fault lines lie.
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