To provide your patients with the greatest medical treatment possible, you and your staff put forth a lot of effort. However, a patient's whole experience may be impacted if medical coding and billing guidelines are not understood. And to make matters worse, your clinic might face fines of up to millions of dollars if you commit medical coding errors. Therefore, read this article to discover the two most frequent errors in medical coding as well as our other recommendations.
Medical Coding Mistake 1: Unbundling
For each patient visit to your medical office, do you bill E/M codes? Such reporting falls under the category of fraudulent medical billing and could result in unbundling. Unbundling occurs when separate billing codes are used for different parts of a medical procedure when only one comprehensive CPT code should be used. According to current medical billing regulations, it is not permitted to divide a service into individual components and code each one separately.
Here's what you should do to prevent the unbundling medical code error:
Don't charge another E/M when the patient returns for the test or operation if the decision was made during an office visit. Trigger point injections (TPI) are an extremely prevalent illustration. If a patient comes in as scheduled for a set of three trigger point injections, the doctor cannot bill the office visit for these injections unless the patient also appears with another issue.
If the patient sees the same provider more than once on the same day, only one E/M visit should be billed.
An incidental operation that is done concurrently with a complex procedure should not be billed separately.
Refer to the Centers for Medicare and Medicaid Services' (CMS) list of medical procedures that are mutually exclusive. Do not use the same patient for two different medical operations.
Medical Coding Mistake 2: Upcoding
Upcoding is when a provider selects a code that is more expensive than the actual process because it represents a more complex diagnosis or operation.
Examples of upcoding include the following:
instead of selecting a medical code based on the severity of the medical problem, billing patients with the same E/M code.
billing a patient for more time than was actually spent with them.
charging a telemedicine patient for a doctor's appointment.
using a complex procedure's code to execute a regular medical service.
using a modifier to point out the presence of extra services when the regular medical billing code already covers them.
billing for durable medical equipment (DME) that was not really delivered.
Unbundling and upcoding, whether deliberate or not, can subject your medical practice to scrutiny and harsh financial penalties. Read the instances of upcoding and unbundling multi-million dollar fines provided by the international law firm Phillips and Cohen. A permanent exclusion from Medicare and Medicaid may also be imposed on the defaulting medical practice.
Working with a reputable, experienced medical coding and billing provider is one method to make sure you don't unintentionally walk on an unbundling/upcoding time bomb.
Since 2003, PracticeForces has provided support to US healthcare professionals, owners of multiple practice groups, and solo medical practices. While staying within the bounds of CMS and HIPAA regulations, our objective is to significantly increase client practice income. If required.