Question

not with handwriting, please

MEDICAL CODING AND BILLING

The Centers for Medicare and Medicaid Services (CMS) released the results from their Comprehensive Error Rate Testing (CERT) earlier this year 2018. The results showed a 9.5% overall improper payment rate for 2017, representing $36.21 billion in improper payments. If any medical practice received some of these improper payments, They could be forced to provide a refund plus incur other additional fees. Discuss on a general basis, the most common coding errors and how to prevent them from occurring at any health care practice.

Answer 1

Most common Coding errors and the prevention in the healthcare practice:

• Lack or missing of information makes the coder to inaccurate diagnostic code. This can be prevented by obtaining an optimum patient information along with the presenting symptoms to diagnose the correct code.
• Wrong identification of patient information will lead to wrong coding. Double checking the patient information with the date of birth before coding whether it is coded on the correct patient. Avoid multiple coding at a time or opening of several windows will prevent this error.
• Another common issue is upcoding which means the improper use of the most appropriate diagnosis due to the confusion of the physician information. This can be prevented by analyzing the patient condition thoroughly before coding. Good communication between the coder and the physician will prevent this type of coding errors.
• The incorrect procedure code is happened due to lack of knowledge of coding rules. Provide adequate knowledge and training to the coder will prevent these errors and best practices in the future. Double checking will prevent half of the coding error.
• Unbundling is the false reporting of patient information which also acts as fraudulent practice. It is the use of multiple coding instead of one code. This can be prevented by good practice and supervision of the coders by the coding leader.
• Guessing is another common error occur due to carelessness and use of shortcuts. Analyze all the information thoroughly before coding. Don't code by using shortcut methods or code too fast. Update the knowledge of the latest versions, the revised guideline will avoid this type of errors.