Filing claims is a crucial responsibility that affects healthcare organizations in today’s climate. Many hours of employee effort and company money is lost due to denied claims. While there are many reasons for denied claims, errors in medical coding has the largest impact of them all.
Let’s take a look at five tips you can use to ensure the medical coding process is completed with minimal errors so that you can save as much money as possible.
1. Verify Patient Benefits
Knowing which benefits your patients are qualified will help you avoid medical coding mistakes. Make sure your payer receives a reminder to check for applicable copayments, co-insurance responsibilities, and remaining deductibles. Double check that all of these things are documented before you go ahead with a claim admission and check if there is a requirement for a prior authorization regarding planned procedures.
2. Collect Patient Demographics
When it comes time to code the claim and submit it, you will need to have patient demographics collected, along with a copy of the patient’s insurance card. Create a policy for your patients that they need to show a government-issued ID as soon as they arrive in your office. This will allow you to verify their identity for your records.
Once you have your patients required documentation, you can then begin reviewing it. It’s best to push out the claim within 72 hours just to make sure you don’t miss any deadlines. Early submissions allow for ample time to call up any physicians you might need to gather information, in case there are any incongruencies in the paperwork.
3. Have Training Materials Handy
You need to ensure that both your on-site and remote coders have the same tools and charts required to do their jobs effectively. You should take inventory of how you plan to resolve potential coder questions, queries for physicians, and how you collect documentation needed for any incomplete charts.
It’s also a good idea to know each if the carrier rules regarding non-physician practitioners. This familiarity will make it easier to avoid being forced to repay claims if an audit takes place. There are usually different rules for private payers including requiring a practitioner to be in the room with a non-practitioner for treatment before it is covered.
4. Choose the E&M and ICD-10-CM Codes Yourself
Don’t leave it up to your coders to decipher what cases have been rendered or which service was determined by which diagnosis. Oftentimes, a coder will get this information wrong if forced to find it out on their own, resulting in a up coded or down coded E&M visit, resulting in a loss of revenue and skewed statistics regarding visits of a high level.
5. Be Mindful of Varied Data Uses
When it comes to writing the medical coding for claims and trying to maximize patient benefits—it’s important to remember that not all data is used in the same way. You need to make sure your coders are all on the same page and adhering to each coding guideline, instruction, and convention as it is required. This is essential for proper filing of the claims future uses of the data. The people who will be leveraging this data rely on the coders to enter it without error so that they can check its accordance with coding rules, guidelines, and conventions.
Your coders must also comply with any data set definitions that are specifically applicable to the situation. For all non-outpatient settings and inpatient settings, your coders need to follow the UHDDS settings when it comes to principal procedure, principal diagnosis, and other diagnoses and significant procedures.
Medical coding is one of the most important steps in making sure you take all the necessary precautions to avoid a claim denial. As long as your coders remember these tips, you should have no problem in the medical coding process and bring your claims denial rates down. This will lead to better patient benefits, and higher revenue levels and satisfaction overall for everyone involved.