3 Common Medical Coding Problems... And How To Solve Them!

Posted by Dave Cowley on Dec 22, 2017 9:08:30 AM

Medical coding is an extremely important part of any medical practice. Having the proper experience and know-how will lead to accurate reimbursements and a compliant office. However, without that knowledge medical coding can dam the cash flow and suffocate the financial situation of your practice. Here are 3 very common problems with medical coding.  

1. Clean Claims - Without a doubt things will happen and some of your claims will get submitted without having everything correct. This happens very frequently, and being able to submit a clean claim will help you get paid faster, more accurately and avoid any issues with compliance. 3 Common Medical Coding Problems... And How To Solve Them!.png

In a recent article Crystal Miner discussed Claims Submission with our readers. The importance of having a defined process is critical to submitting a clean claim. I know you are thinking, "Obviously!" well, that is obvious, however, most people set a process in place and do not improve upon that process. If you are still getting a lot of claims denied, ask yourself a few questions. Why are they getting denied? Who is responsible for that part of the process? How can we remedy that and get cleaner claims submitted? Answering these questions and continuing to improve the process will no doubt allow you to overcome this common problem and achieve a higher rate of 1st pass submissions. 

2. Denials - Reading that word makes most people cringe! Let's first set a standard for what percentage of your claims being submitted should get denied. MGMA has said you should aim to have no more than 5% of your claims denied on the first pass. Re-working a claim and getting it submitted again costs $15 on average. That becomes a huge dollar amount when you are re-submitting a lot of claims. As we discussed earlier, it is wise to put a new process in place, if that is not working and you are still getting denials, there are some additional solutions to help you out. 

Let me be clear that I am affiliated with an outsourced medical coding company, so please note there is some bias with this next paragraph. If you are paying $15 (some figures have it at $25 now) per chart to re-work your claim, why not outsource it to an expert for around $3 per chart? I know some people don't love the idea of outsourcing. However, the ability to outsource frees up your time and saves you money. These experts deal with it all day everyday and will be able to get your denials worked through and get you paid! 

3. Moving Targets - The CMS is an incredible organization with some lofty responsibilities. One such responsibilities is updating the ICD 10 codes on a regular basis. This is important for a variety of reasons, however, that doesnt mean it causes confusion and often leads to some medical coding problems. Without a proper understanding of the coding guidelines and rules, you will get a lot of denials. It is as simple as that. You need to have a dedicated member of your staff that is constantly tapped into the CMS announcements as it pertains to coding changes. Most of the time these changes will not affect you, but sometimes they will and it is vital that you understand them and make an effort to implement these changes in a timely manner.  

There you have it, 3 very common pitfalls with medical coding. They are easy to remedy if you have the dedication and time to put into it. Setup a meeting today and take an hour to review your process and make sure you are not loosing revenue because of these problematic issues. 



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Topics: Practice Administrator, medical coding