Medical coding and billing are staples of any medical practice, as they directly affect the center’s profitability. However, although coding is necessary for claims payment and reimbursement, it is often overlooked when assessing a practice’s health. Many practices have outsourced this function, making oversight of coding, compliance, and accuracy even harder. It is not until a practice has mounting denials or declining revenue that it is even given a second look.
Medical coding has changed a lot in healthcare and continues to evolve. Payers now use system edits ahead of claims processing that can deny or underpay a line item due to incorrect coding, wrong modifier usage, or even an incorrect diagnosis code. Standards like ICD-10 are frequently updated. It is difficult for even the most experienced medical coder, biller, or manager to keep up with the changes. While most coding updates occur annually, payers make policy changes throughout the year. To make it even more difficult, providers are typically not notified and must go to the payer website to obtain updates. Following resources like AAPC can help ensure accuracy, reduce risk, and maintain compliance.
It is important for practices to review coding annually to ensure they are coding correctly and being paid for the services they provide. This process becomes even more important if you have added any new services or procedures for which new coding may apply. Reviewing your coding also supports clinical documentation improvement and helps maintain operational efficiency. If you have not performed a coding review in some time and would like our assistance, please contact us.
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