Avoid Common Documentation Challenges – Choose the Right Medical Coding Company

Avoid Common Documentation Challenges – Choose the Right Medical Coding Company

Physicians can rely on a professional medical coding company to ensure compliance, avoid denial and litigation risks, and maximize revenue.

OUTSOURCE STRATEGIES INTERNATIONAL 8596 E. 101st Street, Suite H Tulsa, OK 74133 Phone:1-800-670-2809

With the changes that ICD-10 has brought about and the alterations in the requirements of government and private payers, the services of a reliable medical coding company can prove invaluable for physicians to ensure compliance, avoid denials and litigation risks, and maximize revenue.

Professional Medical Coding Services - Avoid Accounts Receivable and Legal Problems Here are some of the common medical documentation issues that expert coding services help physicians avoid. 

Failure to code to the highest level of specificity: The seventh character in the ICD-10 codes is a means of applying greater specificity to a diagnosis. It provides information about the episode of care in certain cases. For instance, for injuries, poisonings and other external causes, the seventh character provides information about episodes of care as initial, subsequent or a sequela for injuries, poisonings and certain other conditions; it may also provide additional information about the diagnosis. Not coding to such specificity can lead to a rejected or denied claim.

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Missing or bad documentation: Providing correct and complete information for coding to the highest level of specificity is in the physician’s hands. For instance, complete documentation would include every diagnosis identified, evaluated and treated during a visit. Disease type and location must be clearly specified, as with ICD-10, detailed explanation of diagnosis is necessary to validate payment. This also safeguards the legal interests of the patient and the physician. By working with and educating physicians, a reliable medical coding company helps physicians adhere to best documentation practices.

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Undercoding and overcoding: Undercoding is under-reporting of services provided which leads to lost revenue. Overcoding is reporting more expensive procedures or services than were provided. Both amount to making a false statement and can lead to can lead to federal audits, investigations, penalties and, of course, denied claims.

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Medical coders also work as internal auditors to help practices prevent under/overcoding and ensure that coding and documentation meet federal mandates and compliance. They help health care providers increase their Risk Adjustment factor (RAF) scores by evaluating their clinical and demographic documentation, diagnosis coding, and Hierarchical Condition Categories or HCC coding. Focus on HCC coding and documentation accuracy goes a long way in improving quality of care and performance benchmarks. 

Unbundling: Unbundling is the practice of separately coding procedures instead of reporting a single code that includes the entire procedure. This is false reporting and would result in denials and legal action. One example is separating a surgical approach from a major surgical service would amount to unbundling, such as reporting CPT code 49000 (exploratory laparotomy) when performing an open abdominal procedure such as a total abdominal colectomy (CPT code 44150). An expert coder would not unbundle services that are integral to a more comprehensive procedure.

Outsourcing – A Reliable and Cost-effective Option Outsourcing the coding task to an experienced medical billing and coding company is a practical and cost-effective alternative. These companies are well-equipped with the resources to tackle the tasks effectively and efficiently. They help health care providers increase their Risk Adjustment factor (RAF) scores by evaluating their clinical and demographic documentation, and diagnosis coding. They alert physicians to inaccurate, outdated or missing HCC (Hierarchical Condition Categories) at the point of care. In the current scenario of reduced Medicare payments, HCC coding helps improve coding compliance and clinical documentation to optimize revenues. Their coding team would be up to date with the new codes and new/revised guidelines of payers and also have the skills to handle the daunting claims submission and resolution processes.

www.outsourcestrategies.com

1-800-670-2809