How Does Incorrect Patient Information Impact A Claim?

Coders have to be mindful of how inaccurate coding on their behalf can affect others. Constant training in an organization is a great way to keep coders updated with coding practices and will allow open communication in how to deter errors within the department. Besides affecting patient health and insurance companies returning claims coders should take into consideration that inaccurate coding creates more work for multiple departments within their organization. If more man-hours are needed to correct mistakes facilities lose revenue to spend on resources to improve patient care.

"Medical coding professionals provide a key step in the medical billing process. Every time a patient receives professional health care in a physician’s office, hospital outpatient facility or ambulatory surgical center (ASC), the provider must document the services provided. The medical coder will abstract the information from the documentation, assign the appropriate codes, and create a claim to be paid, whether by a commercial payer, the patient, or CMS." (Aapccom, 2015) It is very important that billing coders have a full understanding of how to properly use medical codes to prevent denial of claims submitted.

-Inpatient coders have certifications allowing them to work exclusively for hospitals or facilities. An expertise in medical record review is a must, along with an up to date status with coding rule changes, regulations and issues for medical coding, reimbursements and compliance under MS-DRG and Inpatient Prospective Payment Systems (IPPS). Coders should have experience as well as expert knowledge in abstracting information from medical records for ICD-9CM vol. 1-3, specialized payment in MS-DRG and IPPS.

The process of developing of an insurance claim will be essential to the healthcare and medical business. And all starts when the patient makes a call to a healthcare provider;s office then makes an appointment. The assigned administrative staff or workers makes certain if the patient is new requesting an initial appointment or an established patient returning for more or additional services required from the provider. Now the pre-clinical interview

If the code is entered incorrectly the patient could get billed something more expensive. The insurance company is also likely to deny the claim that the medical assistant had sent. If the claim is denied, they should go back and review the information. If they find the error they should go through and fix the mistake, then resend it to the insurance company.

When claims are filed documentation must compare to the amount of service provided. The rule is, “if documentation of procedure is not written, it did not happen. Evaluation and Management (E & M) guidelines are checked periodically to ensure medicare and other payers follow guidelines. The E & M informed and update rules and regulations for coding to ensure practices maintain compliance. Physicians has the responsibility of ensuring employees are trained to coding standards and should periodically go over records themselves to make sure all guidelines are followed.

Correct coding is when a claim is coded accurately for example the patient name is spelled correctly date of birth and sex are correct. The insurance will definitely know exactly what illness or injury the patient has and the method of treatment that was performed by the physician. A “clean” claim is one that does not require the payer to investigate or develop on a prepayment basis. This claim is filed in the timely filing period and passes all edits; and does not require external development. A clean claim must have all basic information to adjudicate the claim, and all required supporting documentation is attached to the correct insurance. The required

specific codes are charged to the patient and specific diagnoses entered on a claim for a patient.

Michael, how would you go about making sure that your office is properly staffed and your coders have all the necessary information in order to properly code and process claims? For starters, "the American Health Information Management Association (AHIMA) grants the Certified Coding (CCA), Certified Coding Specialist (CCS), and the

As a nation, we are facing a unique time in the world of healthcare where value-based healthcare determines how a hospital gets paid, and value is priority, it's no longer an option for hospitals to lose potentially millions of dollars due to faulty claims denials. Therefore, submitting clean claims that do not result in denial is the most effective defense your facility has against lost revenue due to fault claims submissions. Just like preventative medicine saves money by preventing medical problems before they occur, submitting accurate billing information the first time around is a more effective way to secure revenue rather than dealing with claims

Proper medical coding is important, from ensuring accurate payment for physicians to creating a valid record of patient care history. In addition to aiding the medical billing process for procedures administered and helping expedite the payment of services for physicians, medical codes also serve the purpose of comparing projects for research and planning for under-served health care areas, aiding in administrative functions, as well as identifying symptoms that have medical necessity and referenced by other physicians or specialists. As an example, for a general urinalysis, the coder must input the code of 81000 for male or female patients. The mistake that could be made is if the coder input 81025 for a specific urinalysis for a pregnancy test. This event could happen if the diagnosis was reversed and a female expecting a pregnancy urinalysis gets a general urinalysis ordered. It may seem minor, but this type of error can still be

As the CFO of Health Care Systems, Inc., I feel like, in order to have proper reimbursement, correct coding is very important. If the codes are wrong, the charges will be wrong, as well. When you submit codes, the federal government uses them to reduce health care fraud. It is always good practice to double check your numbers before you submit them. “So, knowing the difference a diagnosis code of 280 (iron deficiency anemia) and 820 (a fracture of the neck of the femur) will help protect your practice from fraud and

Medical billing and coding are two closely related aspects of the modern health care industry. Both practices are involved in the immensely important reimbursement cycle, which ensures that health care providers are paid for the services they perform. For the sake of simplicity, let’s divide the two at the moment and look at them as separate pieces of a larger process. We’ll begin with medical coding.

When we were working on few claims we happened to come across Clinical department coding error on Claim# 022153. The CDR code is incorrectly populated with an ISO code.

Each field in the database, and a threshold for what percentage of each field must be submitted for a submission to be deemed complete (the rules allow the Commissioner of Commerce and Insurance to waive penalties for insurers that are unable to meet the thresholds if, for example, an insurer does not collect the specified data field).