Conducting regular audits of your coding and billing procedures is a great way to identify and eliminate upcoding and incorrect coding incidences within your practice. In a recent article from Becker’s , it is estimated that hospitals overbilled Medicare by $1 billion from inaccurate coding. The office of Health and Human Services (HHS) Office of Inspector General cited that this incident of upcoding specifically occurred by incorrectly coding severe malnutrition diagnosis codes to inpatient hospital claims, which is classified as a major complication, and have higher Medicare payment rates.
The audit reviewed more than $3.4 billion in Medicare payments for 224,000 claims in 2016 and 2017. In a random sampling of 200 claims, it was found that 173 of the claims contained the severe malnutrition diagnosis code, in which removing that code changed the diagnosis related group. Further, 164 of the claims that used the severe malnutrition diagnosis code when a different malnutrition code should have been used, ended with hospitals receiving $914,128 in over payments. With the given sampling size, HHS estimates this equates to over $1 billion dollars in over payments made in 2016 and 2017 alone.
As shown through this this specific code incident, the overall impact of errors in coding costs insurance companies, Medicare, Medicaid, and end consumers billions of dollars a year. Upcoding is considered a fraudulent activity and is unfortunately a common error. In fact, having a third-party auditing company, like MRA, can help avoid medical coding errors and claims denials.
A third-party coding company helps ensure your practice is using the most recent code set and avoids some of these common errors:
Choosing an incorrect procedure code – There could be notes overlooked, confusion about the procedure, out of date “cheat sheet” information, or incomplete code descriptions in the system are the most common source of choosing the wrong procedure code.
Random use of modifier codes – These are add-on codes that relay specific circumstances related to any service or procedure. Information that is misunderstood or working too quickly can result in modifiers that may not be needed or are used incorrectly in claims.
Not staying up-to-date – Coding regulations are constantly updated and a failure to stay current on the latest rules can result in big coding errors.
Failing to read entire chart notes – Only reading notes on the header of the chart is not enough to fully capture all service and procedure information. There may be additional linking codes needed, and changes or additional final services and procedures performed.
Preventing common and even complex medical coding errors is a vital part to your medical business. MRA has a highly trained and experienced staff of medical coding experts with a 95%+ accuracy rate. Contact us today for your FREE consultation on how our medical coding can benefit your business