Question

What do you do if when you are coding or billing and you realize that a procedure/test has been ordered, but there is no diagnosis to support it?

Answer 1

Medical Coding/Billing can lead to errors that can be fatal and if not corrected on time it can cause consequences like higher claim denials, federal penalties, fines, loss of revenue, and even imprisonment, and hence it is very important to carry out this process very carefully.

Humans are prone to committing error but the problem with such error is that they are not having proper knowledge of the extent of damage it can cause.

This error can cause the emergency medicine practice hundreds of thousands in lost revenue when the insurance companies or government reject the claims with coding error and medical billing and the group are losing money until it gets fixed and resubmit clean claim.

Now the errors are divided into different categories and all have different consequences and impacts.
Here when the coder detects the error and if the coder would not have detected it then it would have fallen under duplicate billing where the provider's office is submitting the claim for a procedure without even getting the procedure done.

This can be treated as a UPCODING error and can be treated as a fraudulent process where the provider intentionally added the work they didn't perform on the patient.Now in order to fix the error before they happen there are few things to consider

-Stay Current
Biller must stay up to date on coding trends and billing and must look for new protocols in medical coding and must study new codes.

-Be Diligent
It is important to double-check the work while creating a claim and must go through each claim before sending it off.

-Communication
Here, in this case, this is the most important step to do and in order to reduce the medical billing error it is critical to coordinate effectively within the provider's office and make sure to communicate effectively and regularly with other staff in the office which can include physical and never be afraid to ask them questions about any possible error that might happen or you have encountered and can cause consequences if not taken care of.

So you should not claim it and code it and must consult it with the officials and check if it is a fault of documents have been misplaced and then act accordingly.