Medical coding is at the core of the healthcare system. The information from medical coding is used in providing patient care, administrative workflow, and in the revenue cycle for any facility.
However, it is estimated that as many as eighty percent of all medical claims contain mistakes and errors, with medical coding issues the most common inaccuracy. In most cases, these coding errors are human oversights or mistakes, but they still take time, resources, and effort to correct. During this process, reimbursements are delayed or claims are denied, which has implications for the revenue cycle.
The following are some of the most common costs of medical coding errors seen today.
- Lower quality patient care – incorrect or incomplete coding may result in patient care problems, including unnecessary appointments and tests or oversight of required tests or specialist visits. It can also result in excessive medical expenses for patients.
- Reimbursement delays and claim denials – errors in coding can cost a solo medical provider tens of thousands of dollars per year, according to the American Academy of Professional Coders (AAPC). At the same time, delays and denials require additional time and effort of staff to correct, which is time they are not working on new claims or providing patient support.
- Lack of revenue – many physicians are providing services for patients that are not coded or incorrectly coded. This can result in lost revenue as well as incomplete patient records, which may limit claims or provide less than ideal care in the future.
- Compliance concerns – intentional coding errors are medical coding abuse and will result in penalties or even possible imprisonment. While most errors are accidental mistakes, they can still result in penalties and possible exclusion from government programs such as Medicaid and Medicare.
Correcting the Problem with a Medical Coding Partner and Technology
One of the most effective ways that small and large healthcare providers can help to prevent medical coding errors is to partner with a service that provides revenue cycle management. Specifically, choosing a partner that offers medical coding and billing services is the most effective way to improve workflow and revenue cycle management.
These service providers use a variety of different options to ensure greater accuracy in their medical coding. Their goal is to eliminate the source of errors, which is the manual or human data entry factor.
Using artificial intelligence software, medical coding is completed accurately and based on the latest in compliance regulations. This dramatically reduces medical coding errors but also increases efficiency, reduces denials, and helps to streamline the revenue cycle. Without denials and delays in payment, the healthcare provider is paid faster, and staff can spend their time supporting patients.
The use of artificial intelligence is not independent of highly trained and experienced coders. When the software detects any irregularities or possible errors, the file is flagged, allowing an experience medical coder to review the claim. Through this process, the artificial intelligence software continues to learn, reducing the number of flags over time without decreasing accuracy.