Strategies Applied By Your Medical Practice To Avoid Coding Errors And To Reduce The Number Of Denied Claims

December 13, 2016

How much money do you lose annually, because of using the wrong codes that result in many denied claims? Admittedly, the codes are complicated and confusion can result, but with time the errors should reduce. If you are having problems dealing with the codes or having far too many denied claims, consider applying the following strategies:

  1. Use Current Diagnosis And Procedure Codes

The CPT book is modified or updated annually. There are several revisions, additions, and deletion done annually and your medical billing specialist should adhere to these when processing the bills and applying for claims.

To avoid any denials, the coders should have knowledge of the new codes and how to use them. The system you use for coding should also be up-to-date. The current coding system is the ICD-10 and if you coders and billers use the ICD-9 codes, the claims will be denied.

  1. Failure To Read The Whole Chart Note

After revision of the codes, the coders must read the whole progress note, so as to capture all the diagnostic information provided. Even though the documentation header has the details on the expected procedure, the same procedure may change with physicians offering more information when giving the diagnosis or the treatment.

  1. Avoid Use Of Truncated Codes

The medical billing system you are using must guide on the coding. The medical coders such as the one working with aesthesia services, ltd understand that they should not use truncated codes.

The codes used should always be the ones that have the highest possible specificity required for the chosen code. The ICD-10 codes must be used presently and not the ICD-9, because the former have a higher specificity with the expansion from five to seven positions.

Truncated codes, with less than the required digits, result in claim denials and delays, because there is no support for the diagnostic procedure used.

  1. Differentiate New And Existing Patients

Most of the evaluation and management service codes set apart new and existing patients giving them different disbursement rates. If a patient is new, they have not had any face-to-face professional service from the provider. This may also be considered if the provider is different, but from the same specialty group of practice. Failure to differentiate these details may result in denial of claims by the insurance company.

  1. Failure To Indicate Corresponding Services Offered

If a patient gets corresponding services by another healthcare profession and the details are not input in the final bill, the claim may be denied. The specific codes must be input at all times.

  1. Use Correct Corresponding Codes

The diagnostic and procedural codes are different. Failure to indicate the correct code for either of these services will lead to the denial of the claim. This is because the codes did not match.

In conclusion, these strategies will reduce the number of claims declined by the insurance companies. This increases patients’ faith in your services resulting in higher revenues.

Patrick Summers is a medical billing expert at Anesthesia Services, ltd. When he is not dosing and ensuring coding compliance, he cooks, as a professional sous chef.

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Andi Perullo de Ledesma

I am Andi Perullo de Ledesma, a Chinese Medicine Doctor and Travel Photojournalist in Charlotte, NC. I am also wife to Lucas and mother to Joaquín. Follow us as we explore life and the world one beautiful adventure at a time.

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