Medical coding is integral to healthcare Revenue Cycle Management (RCM), ensuring that providers receive accurate reimbursement for their services rendered. Whether minor or severe, medical coding errors can lead to problems down the line. Issues such as claim denials and processing delays can be huge financial setbacks that can impact your organization and the patients you serve. Medical coding errors can be easily avoided, so let’s explore some common mistakes and the solutions to prevent them from happening in your healthcare company.  

According to the Medical Group Management Association (MGMA), nearly 20% of all claims are denied, with coding errors being a leading cause for denial. Additionally, 60% of denied claims are never resubmitted, resulting in lost revenue. The cost of reworking or appealing denials further burdens medical practices, averaging $25 per claim for medical practices and up to $181 per claim for hospitals. Errors not only contribute to revenue loss but also increase healthcare staff’s admin workload.  

How to Prevent Common Medical Coding Errors 

By identifying and addressing common medical billing mistakes, your healthcare firm can avoid medical insurance claim denials and maintain financial health: 

1. Claims Not Specific Enough 

Insurance companies require precise codes to process claims correctly. Using incorrect, outdated, or unspecified diagnosis codes (such as those ending in “.9” in ICD-10) when more specific options exist can likely result in denial. Medical coding mistakes like these are understandable — confusion between ICD-10 and CPT codes among billers is a common occurrence! 

To avoid this, healthcare firms should invest in comprehensive training for billing staff. First, to train them on keeping accurate patient information, diagnoses, and procedures in the database. And second, to regularly calibrate and stay up-to-date on changes in coding regulations.  

2. Incomplete Information in Claim 

Even minor omissions can cause claims to be rejected. Larger healthcare providers with dedicated billing departments may experience fewer cases of this happening, but smaller or busier organizations with limited staff may encounter these issues more frequently. 

Attention to detail is crucial. Billing staff must be meticulous in recording patient information, including provider credentials and authorization numbers. It can also help to have a secondary review process or an additional layer of staff for auditing before claims are submitted.  

3. Claims Not Filed on Time 

Insurance providers must follow strict deadlines for claim submission, and the timeframe can vary from provider to provider. Missing these deadlines results in automatic denials, often with no opportunity for resubmission.  

To prevent this, staff should be aware of specific deadlines for all insurance providers you deal with and set internal reminders for timely medical claims management. Another way to minimize delays is by automating the submission process. Automation makes it easier for auditors to regularly check claims timeliness, ultimately reducing backlogs for your firm and eliminating bottlenecks in processing claims.  

4. Upcoding and Undercoding 

Upcoding occurs when a provider bills for a higher-level service than was performed, while undercoding happens when a less expensive code is used instead of the appropriate one. Both types of medical coding mistakes can trigger audits for your firm and result in automatic claim denials.  

Training staff on proper documentation and coding practices is essential. Additionally, some healthcare organizations may choose to scale their medical billing operations by outsourcing, which can provide specialized, expert support for handling coding accuracy and compliance.

Solutions for Reducing Medical Coding Errors 

These are just a few of the most common errors. To minimize their impact on your firm’s coding and billing process, here’s what you can do: 

  • Invest in Comprehensive Training: Keeping medical coders and billers informed on regulatory changes and best practices can significantly reduce errors. Implementing workshops and refresher courses can help ensure accuracy and compliance. 
  • Leverage Advance Tech: The innovation of medical coding software and automated electronic medical records (EMR) have made it easier for firms to adopt a more efficient and even paperless workflow. Integrating your firm with these technologies can help you detect and correct errors before claim submission and reduce the risk of manual mistakes.  
  • Establish Quality Control Measures: A structured quality assurance process, including random claim audits and double-checking codes before submission, can catch errors before they are submitted.  
  • Outsource Medical Billing: Outsourcing medical billing is an effective solution for healthcare organizations experiencing high denial rates or facing staffing challenges. When you outsource medical billing, you are connected with a remote team of professionals focused solely on medical billing and all aspects related to coding and claims. One of the top benefits of outsourcing medical billing is that you can ensure compliance and reduce errors, empowering your in-house staff to deliver maximum efficiency and focus on giving excellent patient care. Furthermore, hiring a remote team through a Business Process Outsourcing (BPO) company allows you to stay on top of changes in regulation. Remote teams are continuously trained, with a QA team overseeing consistent quality control.  

Improve your medical practice by leveraging outsourced medical billing services for insurance claims. Partner with FGC+ today and build an elite team of professional remote billing staff. Learn more about our comprehensive outsourcing solutions for medical billing and more at www.fgcplus.com.