Every so often, claims submitted to a healthcare organization’s billing department are inaccurate. Many administrators and other players in the medical practice attribute this to the complexities of the medical coding systems. For many healthcare facilities, mistakes emanating from healthcare coding and billing are inevitable and costly. For instance, they may cause denial or delay in payments. Common issues in medical coding and billing include incorrect procedure codes and inadequate data.
Incorrect procedure codes are avoidable errors that may involve a slip of a finger. When this happens, an issue of a wrong entry procedure emerges. This can also occur when patient information is inaccurately documented in patient data ( Johnson & Linker, 2015) . Insurance providers usually return such claims on the grounds of incorrect procedure codes ( Force, 2012) . The issue can indicate that members of the organization charged with the responsibility do not observe and adhere to the codes outlined by the organization.
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Insufficient data arises when a hospital fails to provide critical data supporting claims. An excellent example to illustrate this is when an employee in the billing department unknowingly fails to link diagnosis code, and Healthcare Common Procedure Coding System (HCPC) code or even fails to complete the digits ( Korb, Scott, Franks, Virapongse, & Simpson, 2016) . Although employees often make this mistake, at times, physicians often submit inaccurate diagnosis information.
Many coding and billing issues in the healthcare sector are avoidable and caused by inadequate or inaccurate medical documentation. It is a serious issue affecting many hospitals’ revenue life cycle due to delayed and denied claims. From the two examples mentioned above, a recommendation for an organization experiencing challenges in medical billing and coding is to implement effective and efficient systems on the process and procedures and regularly train their workforce on the function.
References
Force, R. T. (2012). Reimbursement of advanced practice registered nurse services: A fact sheet. Journal of Wound, Ostomy & Continence Nursing , 39 , s7-s16.
Johnson, S. L., & Linker, R. (2015). Understanding medical coding: A comprehensive guide . Cengage Learning.
Korb, P. J., Scott, S. J., Franks, A. C., Virapongse, A., & Simpson, J. R. (2016). Coding and billing issues in hospital neurology compensation. Neurology: Clinical Practice , 6 (6), 487-497.
