Under-coding is one of the most serious problems in medical billing. It not only affects the practices bottom line when higher revenues are not realized, but it can trigger an audit by government agencies. Why does under-coding happen? It is often a result of fear or lack of knowledge. When medical providers don’t understand what medical billing is really all about, the billing codes get compromised and as a result there is second-guessing on what codes to use and when it is appropriate to use them. On the other hand, when these billing codes are overused, this can result in prohibited practices discovered through an audit.
There are hundreds of medical billing codes and it is for a good reason – they all need to be used. If you are managing a doctor’s office, you serve a wide array of patients each with different problems. Some of them have serious diseases and others just come for routine checkups. If a biller is not familiar with the current codes in medical billing, they may already be under-coding in using the same code for all kinds of visits.
At a glance, it may sound as if under-coding is better than over-coding but in reality doing either will be a huge problem as they might both trigger an audit. When this problem triggers an audit, under-coding will stand out because it has been overused.
This problem will also cause financial hardships for the practice. As we all know, medical professionals have the right to their earnings, they need all the earnings they can get these days– down to the last cent. If a medical provider is doing more services than covered by a general office visit and yet they are billing as if, it is hurting the practice financially.
As medical coding gets more complex, there is an even greater risk to under-coding as the professional biller can easily fall behind in the field, making mistakes thereby putting the practice in financial jeopardy. Proper medical coding is the best way to insure healthier revenue generation for the organization. First the biller needs to get educated and get updated with the current practices and processes. This entails at least an extra two hours per week just to take educate themselves on proper medical billing. Or, a practice can simply outsource the billing is facet of the practice to a third-party company such as MedPro Services. MedPro Services sole purpose is to maximize revenue for medical practices thereby keeping up to date and knowing the right codes to use is the nature of the business.
In medical billing, under-coding should never happen. Billing professionals should never lack the knowledge of proper and complex coding. Although, it may be nice to charge less just to avoid errors, this will hurt the financial well-being of the practice especially if there are other options available. The practice may lose thousands of dollars every year because of under-coding. The money lost might be better off spent in hiring a good medical biller, buy new equipment, hire a nurse and many other things. If you are interested in maximizing your practices revenue, give MedPro Services a call.
Think you don’t need medical billing agencies? Studies show that over 50% of claims that are lost or denied are never pursued by medical practices.
Why not? A practice often finds itself overwhelmed with the day-to-day tasks of patient care. With the ginormous size and complexity of effort and expertise it takes to accurately bill and receive adjudication from insurance companies now; it is no surprise that experts contend that medical groups could be losing as much as 20 percent of potential revenue. Couple that with the loss of a key employee and a practice could be in financial distress.
In today’s economy, it is important that the medical practice get every penny out of every claim they submit to insurance. Most importantly, they must work diligently to ensure that not only every claim they submit has the highest probability of reimbursement , but that the reimbursement must be for the correct amount and not an underpayment.
Claims management is very important to a medical organization. It is the highest priority of medical billing agencies. What this means is that the work the provider and staff put in for that patient visit or procedure gets created into a claim that is submitted to the insurance company. Then in turn, the practice is reimbursed as soon as possible.
Claims always need to be followed up to make sure:
the claim has reached the payer
the payer has processed the claim
whether the claim has been adjudicated or denied
denied claims needs to be researched, corrected then resubmitted
once the claim is finally reimbursed, it is so at the highest dollar amount possible
High claim revenues begin with due diligence and attention to detail. The staff must make sure patient insurance information is up to date. This often means that insurance card information must be collected, validated and entered into the system at every visit. A professional then must enter the charges correctly. The coder must code the procedures according to coding standards and according to that particular insurance company’s specifications. Then the claim needs to be submitted to that insurance company in a timely fashion. Timely fashion not only means submitting the claims before deadlines, but submitting the claims as soon as possible so that the medical practice can income is realized in the least amount of time.
Good medical billing agencies like Medpro Services stays on top of all claims submitted to make sure they have been received and paid fastidiously and correctly by the insurance companies. We alleviate extra costs and hassles for your practice.
Knowing what you do now, how can you not call Medpro Services?
Although MedPro Services is best known for our orthopaedic (orthopedic) billing services, we also have experience and expertise working in the following medical specialties:
If you are interested in learning more about how our medical billing services can cut your internal cost and increase your profitability, pleasecall 1.866.MEDPRO.8 (866.633.7768) or complete our Free Office Analysis Form
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