Medical coding guiding healthcare providers for insurance claims

  • Written by Yash Rajan
  • Monday 5th September 2022
Medical coding guiding healthcare providers for insurance claims VLMS Healthcare

Medical coding is increasingly getting attention as many countries focus on digitizing their healthcare infrastructure. Medical coding when done right can help with reimbursements and adherence to national guidelines. It assists the medical organizations in completing the billing process for medical services without facing compliance penalties and distrust investigations. Improper medical coding, which may result from improper documentation or a compromised billing invoice, can trigger a federal investigation regarding medicare fraud on a particular organization. Such practices result in compliance expenses and damage the image of any organization. Thus, many organizations are now seeking regulatory companies which solely focus on managing the compliance procedures for insurance claims. These companies help conduct regulatory audits and provide assistance during every stage of the reimbursement procedure, from medical coding to handling denial claims. Medical coding starts with reviewing the medical data received from the healthcare service providers. This data includes patients' information related to diagnosis, laboratory and radiography results, and other services and devices used during their treatment. After a positive review, the medical coder then converts this physical information into digital information as codes. These codes then serve as working information for completing the billing process of insurance claims. After completing the billing process, the healthcare service provider is then paid the reimbursement.

One of the major challenges for medical coding is receiving incomplete or compromised information. Often, this is the reason for the denial of insurance claims. Frequent regulatory audits or coding audits ensure that patient information is being documented as per the federal guidelines. It ensures the integrity of the medical information, which further leads to successful insurance claims.

Audits also help the healthcare service providers understand medical coding and the importance of proper documentation in coding. Coding audits can highlight:

  • the errors in medical coding
  • and the errors in documentation from the healthcare service providers.
  • The awareness of medical coding among healthcare professionals.
  • Compromised billing practices.
  • Corrupted staff members in an organization contributing to billing frauds.
  • Risk assessment in future insurance claims.

A frequently asked question about the medical coding audits is regarding their frequency. What is the ideal frequency of performing a medical coding audit? To answer this question, one should understand the organization in question.

Information such as the organization's size, contributors to the medical documentation, services, and equipment available, and the expenses for performing a coding audit can help decide the frequency.

Many organizations now perform coding audits every quarter, which gives enough time to implement the changes based on the previous audit. With the growing burden and complexity of compliance procedures, many organizations are now opting for monthly coding audits. Monthly audits help in quickly eradicating the errors responsible for claim denials. Monthly audits also help roll out the frequent coding and documentation software updates. Both monthly and quarterly audits provide better risk assessment than yearly coding audits.

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