Consequences of Inaccurate Coding and Incorrect Billing

July 16, 2019
by Admin

Medical coding is a vital component of the revenue cycle process that needs to be handled with diligence and extreme accuracy. If these services are mishandled, it can have significant consequences on your practice. Here are some examples:

Impact on the Clinic

Affects Reimbursement: Improper coding leads to improper billing, which can directly impact a clinic’s bottom line. Incorrectly down-coding a major procedure as something less accurate will result in lower reimbursements.

Adds to Administrative Time: When improper billing occurs, upper-level staff must handle damage control. Having to clean up these errors is an inefficient use of time that should be spent on more practical tasks instead.

Causes Errant Fraud: If your practice fails to note the mistake and attempts to rectify it, the recipients of the errant bill can make a case for fraud. If incorrect charges go through in full, your practice can be hit with upwards of $10,000 in damages, plus 10 years of jail time per claim per CMS (Medicare/Medicaid) Guidelines.

Impact on Patients

Hinders Patient Safety: Medical coding as a system is dependent on consistency. Even a mistake as simple as swapping the place of two digits in a code during the authorization process can indicate a wildly different diagnosis. This can cause denials and delay services, revenue as well as destroy the patient experience.

Affects Patient Satisfaction: Incorrect medical coding and/or billing can negatively impact your patients’ experiences outside of the office, which can affect your reputation. If a patient receives an exorbitant bill for a procedure he or she did not have, they might view it as a scam. If the service listed doesn’t match the client’s claim, or isn’t covered by his or her policy, the coverage may be denied. Patients who end up in debt because of errors from your clinic aren’t likely to return.

There are some great products on the market to drive engagement and eliminate these errors well beyond the billing and coding processes such as SafeStart Medical.

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