Medical coders tend to work behind the scenes in the healthcare industry. Most people who visit their doctor’s practice or a hospital will never see these individuals doing their job. However, medical coders are a vital part of the healthcare industry as without them healthcare facilities would not be reimbursed by insurance companies and agencies such as Medicare and Medicaid.
What do Medical Coders Do?
If you don’t already know, medical coders are responsible for taking patient files and translating the information on them into specific medical billing codes. The folk at Find-A-Code.com tell us that the work medical coders do is vitally important. What they are essentially doing is translating information on patient files into a language that can be read by the insurance companies, who will then reimburse the healthcare facility based on the information they have received. Medical coders need to make sure they code files accurately to ensure that the correct amount is paid. Accuracy is key when it comes to the work that medical coders do.
Why Does Accuracy Matter So Much?
A medical coder must assign specific codes to every aspect of a patient’s visit. Not all parts of a visit will be covered by the patient’s insurance company, so it is necessary to get the coding right. In some cases, a medical coder will also be responsible for creating the bill to send to the relevant body. Sometimes, a large healthcare facility will employ separate coders and billers. Regardless of who is responsible for billing the insurance companies, the importance of correct coding cannot be understated.
For example, if you as a medical coder incorrectly assign a code to a specific treatment, medication, or administrative task carried out at a patient visit, it could mean that the insurance company refuses to pay out. Maybe you have made a mistake and assigned a code for a treatment that is not covered under the insurance plan.
If you are lucky, the insurance company will realize that a mistake has been made and will send the claim back for correction and resubmission. However, there may be times when the insurance company will reject the claim and you will not be allowed to resubmit it. This means that either the healthcare provider or the patient will be out of pocket.
Common Coding Mistakes
Mistakes in coding can occur for a variety of reasons. It may be that the coder is rushing and not paying attention to detail and has incorrectly copied a code. Or it could be that they have misread a patient file because of illegible handwriting on the part of the physician. It is important to take great care when coding to avoid such errors. Attention to detail and accuracy are two of the most important parts of a medical coders job. If you are unsure of what a physician has written in a file, it is your job to ask for clarification.
Other mistakes include upcoding, which can occur when a coder has used a code for a more expensive procedure. For example, a test that was carried out by a technician will be reimbursed at a lower rate than if it were carried out by the physician. It is important to confirm who conducted a test before assigning a code.
Another quite common mistake in coding is called unbundling, where a series of procedures are separately coded instead of being bundled under one code. This results in higher payments by an insurance company but is classed as fraudulent and can carry heavy penalties.
As you can see, accuracy in coding is massively important.