Medical Coding & Billing Errors: The Big Consequences

Bob Miller

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Mistakes are inevitable when you’re dealing with a system as complex as hospital billing. Some sources cite the error rate as high as 75%. The impact of these errors can have huge consequences for the bottom line of your facility. Here are some of the most common mistakes we see in coding and billing and how they can impact your hospital.

Most Common Medical Coding and Billing Errors

Hospital medical billers are tasked with almost an insurmountable challenge as the complexity of our nation’s healthcare practice increases. Some of the most common errors in coding and billing today include:

  • Failure to provide enough information to payers to support the claim. This error could stem from the doctor failing to provide accurate diagnosis details or could be strictly a claims error.
  • Upcoding costs patients and payers’ big money when the coder ends up billing out for services that weren’t really provided. This often stems from a miscommunication in documentation between the doctor and biller.
  • Telemedicine, which has increased in usage since COVID, often bills without the appropriate GT or GQ modifiers in place. It doesn’t help that these rules have evolved during COVID, either.
  • Incorrect procedure codes

Simply missing information can cause claim denials or delays. Simple things like a patient address or dates of treatment can foul up an already complex system of reimbursement. How do these errors impact your system of care?

The Lasting Impact of Coding and Billing Errors

Many people in the hospital touch the coding process. However, Physicians Practice points out that “doctors should know that liability ultimately falls to the provider whose National Provider Identifier (NPI) the service was billed under.” So, the consequences of a failed claim ultimately roll back to the doctor under the current system of care. However, we should note that these errors are certainly not malicious in nature but due to workflow breakdown at any point during the patient treatment and reimbursement process.

The impact of coding and billing errors in any hospital is high. First, cash on hand is ultimately affected as providers wait for reimbursement that is delayed. Billing is obviously deferred, and more human hours are required to fix the error. If claims are coming back frequently in a consistent pattern, government regulators may also flag these accounts for review. This ultimately reflects poorly on the doctor and hospital. In a worst-case scenario, the doctor and hospital could be held liable for fines, or worse the Centers for Medicare and Medicaid Services (CMS).

Ultimately, coding and billing errors drive up the cost of care. This impacts patients and payers, as we struggle under the constraints of an increasingly complex reimbursement system.

Finding the right coding and billing teams will help your hospital improve its reimbursement process and ultimately its bottom line.  Our recruiting guide at MedSource Consultants can help you find the best talent.