Mistakes in the billing and coding process can take many forms, from incorrect ICD coding to ethical violations. In this revealing article, Nitin Chhoda examines the most common errors facing billers and coders, and identifies ways to avoid them.
Billing and coding specialists work with protected information every day. Their actions have an impact on their employer, payers and patients. It’s essential that they maintain the highest ethical standards and are cognizant of laws that could inadvertently be broken.
Dishonesty
Billing and coding staff work with facts that are backed up by practitioners with documentation. Never assume and don’t include codes that are only implied.
Appropriate documentation must accompany every claim and support the clinician’s diagnosis and treatment. Neither should codes be unbundled to claim additional reimbursement. Codes should accurately reflect the patient encounter.
The Blame Game
If a mistake is made, accept the blame instead of trying to foist it off on another billing and coding staff member. If a problem exists in the claims process, address the situation with the appropriate individual.
Over Billing
Many practitioners record every action during the patient encounter, but that doesn’t mean every detail is billable. Only claim procedures and treatments that are supported by documentation and don’t second guess the clinician. If doubts or questions exist, clarify with the practitioner.
Unbundling
Some actions are incidental to specific procedures and shouldn’t be billed separately. Learn which procedures can be bundled and which ones can’t to ensure accurate billing and coding.
Ignoring Errors
A mistake can be anything from an omission or incorrect code to a transcription problem. When errors are discovered, they should be brought to the practitioner’s attention. Fix the problem immediately and submit a corrected claim. Ignoring an error can result in payments to which the clinician isn’t entitled and opens the door to fraud.
Overpayments
Even when claims are submitted correctly, errors can occur in billing and coding that result in over payments. The payer should be notified of the mistake immediately. Be prepared to follow the necessary procedures to return the funds. Doing so reinforces the practice as a desirable partner.
Failure to Protect Patients
Clients may be required by their insurance company to only see certain providers within the payer’s network. Failure to do so can result in costs the client can’t pay and no reimbursement for the clinician. Patient coverage and benefits should be verified by billing and coding staff before their visit.
If there’s a problem, the client can be advised of their options prior to treatment.
Authorizations
More payers are demanding pre-authorizations before they pay for services. Failure to obtain the appropriate authorizations or referrals can result in billing and coding claims being denied and loss of payment for the provider.
Patient Confidentiality
The law protects patient information and anyone who discloses personally identifiable data is in violation of HIPAA regulations. Penalties for violations include significant fines and jail time. It’s imperative that all staff members, including those in medical billing and coding, are aware of HIPAA laws and consequences of breaking the patient’s trust.
Unscrupulous Managers
Some billing and coding managers aren’t as cognizant of coding rules, procedures and penalties as they should be, and they may even urge those in their charge to ignore or overlook issues.
Don’t be afraid to report such matters to the manger’s superior.
Mistakes are inevitable, but they should be rectified immediately. Precautions should be taken to protect patient information and uphold the highest of ethical standards to protect the integrity of the billing and coding staff, and the practice.
