How to Avoid Common Medical Coding Errors

Medical coding mistakes can increase claims denials and lags in reimbursements – not to mention receiving incorrect bills can also frustrate patients and negatively impact their care.

Even though medical coding mistakes are incredibly common, thankfully, most of these errors can be easily avoided. Practices that optimize medical billing maximize reimbursements, reduce the risk of fines and fees, and boost patient satisfaction by transparently communicating healthcare costs.

In this article, we’ll review five common medical coding errors and ways to avoid making these mistakes.

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Five Common Medical Coding Errors

Incorrect Patient Demographics and Information: Mismatched patient information can increase claims rejections. It’s important to double-check each patient’s name, birthday, address, and insurance provider information. Remember to review the dates of consults, visits, and treatments.

Mixing up ICD-10 and CPT Codes: Many medical coding errors are due to the wrong combination of diagnostic and procedural codes being entered. Practices may inadvertently lose potential revenue by incorrectly billing why patients required a certain procedure.

Using Out-of-Date Codes: There are more than 100,000 ICD-10 and CPT codes, and medical code guidelines change annually. Using outdated codes may result in claims denials. Investing in new guideline manuals each year and regular training for medical coding staff can prevent the use of old codes.

Upcoding: Medical upcoding is a fraudulent act that can cause practices to be audited and pay potentially high fines. Upcoding occurs when a practice submits a claim to insurance that inflates procedures provided to the patient to receive a higher reimbursement rate. To avoid inadvertently upcoding claims, make sure billing personnel always use the appropriate CPT codes for the procedures performed and review coding guidelines regularly. And, if you’re planning to outsource billing services, make sure you select a reputable vendor with high ethical standards.

Duplicate Billing: Duplicate billing is also a form of fraud that can result in legal penalties and fines. This occurs when medical providers issue multiple bills to different payors for a single procedure. Also known as “double billing,” the provider may receive duplicated payments from a patient, their private insurance, and government insurance providers, such as Medicare and Medicaid. Duplicate billing can be avoided by ensuring patient records are correct and only entered once into billing software.

Ways to Avoid Common Medical Coding Errors

Stay Up-to-Date With Coding Changes

Since new codes are added and tweaked annually, best practices for how to code patient diagnostics, encounters, and procedures performed will vary a little bit each year. 

Use an EHR With Built-In Coding Recommendations

EHR coding recommendations reduce medical coding errors and streamline manual data entry. Benchmark EHR offers built-in CPT and ICD-10 code recommendations based on a patient’s medical history or diagnoses, and a user-friendly search function to make finding and inputting the right codes a faster process. Learn more about EHR Coding Recommendations.

Hire Dedicated Billing Specialists

Whether you have an in-house billing team or outsource your revenue cycle management, it’s critical to hire experts who are uniquely qualified and trained to submit claims. For many practices, outsourcing medical billing services can save costs while improving first-pass clean claims rates, increasing collections, and reducing time to AR from an average of 56 days to just 30 days.

Collaborate With Payors

Working with insurers before procedures can help reduce claims denials and improve revenue cycle management. Gaining prior authorizations also benefits patients. They receive fewer surprise bills and have more peace of mind before receiving medical care knowing insurance will cover a portion of the costs. Learn more about how practice management software helps providers manage prior authorizations.

Benchmark Solutions helps prevent common medical coding errors and boost revenue

Here are the top reasons why Benchmark Solutions comes highly recommended by medical practices across North America: 

  • Benchmark RCM clients reduce AR to less than 30 days, achieve a 98% clean claims rate, and improve collections by 10-15% in the first year.
  • Benchmark EHR users streamline medical coding with built-in ICD-10 and CPT code recommendations.
  • Benchmark PM clients benefit from customizable billing work lists, integrated claims management, prior authorization management, and flexible reporting.
  • All Benchmark Systems clients have access to a five-star support team across platforms.

Want to learn more about Benchmark Systems’ suite of high-powered, intuitive, and customizable medical collections software, practice management, and revenue cycle management tools?