Undercoding: Tips To Avoid This Pitfall

In the world of quality reporting, undercoding can be as damaging to your revenue cycle as overcoding can be.

Undercoding forestalls an audit. It leads to failures in credibility issues and legal repercussions. Most importantly, it causes the loss of thousands of dollars every year to medical practices.

A recently released survey by the technology vendor BESLER and HIMSS media reports that health care providers are concerned that medical coding processes vulnerable to errors may cause decreased revenue.

In 2008, Medicare reported that medical practices lost nearly $236 million to undercoding.

Deliberate undercoding is defined as a “false statement.” It relates to a misrepresentation of the facts.

Undercoding establishes false utilization patterns. It may present a medical practice as an outlier, making him or her direct target for payer investigation and/or audits.


Tips to avoid Undercoding errors

Medical groups may use some strategies to avoid coding errors:-

Use analytic and benchmarking tools

To increase profitability in today’s challenging healthcare reimbursement world, the medical group needs advanced analytic tools to know what their earning should be.

Using medical billing analytic tools, physicians can average their own procedures. It helps to avoid miscoding, audit risk, and loss of revenue.

Using benchmarking data helps providers compare fees, profits, and procedures to their peers. An E/M utilization benchmark tool helps physicians compare a practice’s evaluation and management (E/M) CPT code utilization to peers in the same specialty.

Train coding and billing staff

It is recommended that you should outsource your medical billing. It’s a time-saving and hassle-free option. It is good for medium- and large-sized healthcare facilities.

If you have an in-house coding and billing staff, you educate them about the consequences of undercoding and train them to avoid this error.

Your staff should use the proper codes. They should not succumb to undercoding to the fear of a claim denial.

Use a quality Electronic Medical Records System

The use of Electronic Medical Records (EMR) is beneficial for both patient and doctor as reduction of error in medical coding saves money to both parties.

Using an EMR system, physicians can store and track patient data over an extended period of time. It helps them to accurately report various health care services provided. It includes medical history, diagnoses, medications, doctor’s notes, immunization dates, lab results, etc.

Use Uniform Coding

Provide uniform coding for all patients: fully-insured patients and those who pay in cash. The discrepancy in codes for the same procedures can lead to discriminatory billing.

Perform Internal Audits

Periodic internal audits of your documentation, coding, and billing are the best way to detect and avoid undercoding. It ensures that your documentation correctly reflects the work done.  

Internal audit should evaluate compliance with payer reimbursement guidelines. It involves comparing the guidelines to your documentation to ensure all procedures and diagnoses are appropriately billed.

Physicians should share the results with the coding and billing staff. Compliant procedures and policies should be updated regularly to prevent potential coding errors.  

An external auditor, periodically, is important to validate the effectiveness of your internal audit program.

Get Professional Assistance

According to research conducted by the National Business Research Institute (NBRI), for today’s busy medical practices to prosper and grow, billing should become seamless and patient friendly.

There are a number of advanced software to enhance in-house coding and billing efforts. Outsourcing medical billing can be one of the soundest decisions for the private practice owner.

You can refer to Greenbills medical billing and coding services to get assistance from specialty-focused billing experts. It is a patient-friendly and easy-to-use platform that helps medical group in creating error-free bills. Our primary objective is to focus on maximizing the insurance payments by correctly processing your claims.

Contact Greenbills to increase your reimbursements and stop worrying about collections.

For more information, fill out the form below, send us an email at he***@ge***********.com or call us at 888-274-3755.

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