An Ounce of Prevention: Coding and Billing Challenges for Physicians

As the saying goes, "An ounce of prevention is worth a pound of cure". When it comes to circumventing medical coding and billing errors, getting claims paid quickly, and putting an end to the waiting game, a truer word was never spoken. As stated in an article in Medical News Today, navigating the complicated maze of rules, regulations, and correct coding initiatives present special challenges for physicians. According to MSNBC, medical billing errors are becoming more common, due to clerical errors and items being billed separately instead of as part of the surgical package, for example. Coding and billing errors are not limited to physicians and hospitals, however. Anyone can make errors at any stage of the process, and human nature being what it is, they can happen in the most efficiently run offices and can be caused by any number of factors, as outlined in For The Record Magazine. As detailed in the Physician News Digest, almost anything can happen: Two numbers in an ICD9 code become transposed accidentally; an E/M service, done with a separate procedure, does not include the necessary
-25 modifier; a service level is inadvertently upcoded without supporting documentation, or intentionally downcoded to avoid raising eyebrows.

Or maybe there's a simpler explanation: Maybe the doctor's handwriting is illegible, resulting in inaccurate interpretation and coding.

This is why it is important for everyone to take responsibility at each stage of the process: physicians, coders, office managers, billers, auditors, and medical transcriptionists. We all play a role in avoiding common coding mistakes. We are "passing the baton" to each person in the next stage of the coding process, so education on correct coding, compliance, and reimbursement is crucial, and is a neverending process. Taking this step on the front end maximizes reimbursement potential, while minimizing prospective claim denials. Remember CCI Edits are your friend, and Medicare makes them available on the web. It is also a good idea to perform random and routine self-audits. A self-audit ensures charts are accurate, legible, and complete, with all of the necessary supporting documentation to avoid claim denials. Just like an ounce of prevention is worth a pound of cure, "a stitch in time, saves nine". So being proactive and taking the right steps to minimize potential claim denials by avoiding some common pitfalls, can reduce a lot of headaches later.

Since we are all "in this together" as the saying goes, what are some of the challenges that you face as a coder, biller, or office manager, when trying to get claims paid accurately and quickly? Name some areas where you think physicians might benefit from additional education on coding and reimbursement? How do you spot "hot spots", i.e., potential billing and coding problems that aren't a problem now, but might be a problem tomorrow or next week? What have you learned through experience? What would you tell a new coder or biller to "be on the lookout for" when it comes to coding, billing and maximizing reimbursement?