The Importance of Accuracy and Compliance in Billing and Coding

Always Ensure Accurate and Compliant Billing and Coding

When managing a medical practice, you undoubtedly have several things to worry about at any given time. Medical billing and coding is difficult to keep up with, especially with evolving laws, regulations, and medical codes. These changes make it difficult to be compliant even for the most astute practices. Unfortunately, failure to have accurate and compliant medical billing and coding can result in several negative ramifications for your practice. Here are the top three reasons it is vital to be accurate and compliant in billing and coding all of the time, and some of our tips for achieving greater accuracy and compliance.

1. Financial Protection of Your Business

Inaccurate billing and coding can have serious financial consequences for your business. Often, it will result in your practice not receiving the full amount it is entitled to from the patient and/or insurance company. Sometimes this amount can be small on a per claim basis and may not seem like a big deal, however, we have seen this cost practices tens of thousands of dollars over a period of time. Inaccurate or noncompliant billing and coding can also leave your practice vulnerable to a lawsuit. By maintaining accurate billing and coding protocol, you can ensure your practice is achieving compliance and is financially protected, while reaping the benefits of boosted revenues.

In addition, inaccuracies can cause delay and/or denial of your claim and therefore payment altogether. And if your practice does not have a robust denial management strategy and protocol, claims such as this may be simply resubmitted erroneously or even written off entirely.

2. Protection for Your Patients

Medical coding is utilized to pinpoint and document exactly what diagnoses and treatments were performed during a patient’s time at your practice. This documentation remains a part of the patient’s medical record, so it is important for the protection of your patient that it is absolutely accurate. From lab results, to x-rays, to medications prescribed, the patient and designated patient’s family may at any time need access to this information. Inaccurate information can harm the patient and can harm the quality and accuracy of future care. It is irresponsible to put patient health at risk because of something like inaccurate coding.

3. Forecasting for the Future

When your practice is compliant with all medical coding protocol, it is much easier to ensure that billing to patients and insurance is accurate. Accurate billing allows your practice to forecast for the future. Your medical practice will be able to analyze accurate data on revenue, costs, write offs, et al giving your practice the ability to make informant decisions about your business and prepare your practice for financial success in the future. Accurate billing will help with making important business decisions that may involve staffing, patient outreach, and adding service lines to your practice.

How to Achieve Stronger Accuracy and Compliance at Your Practice

Now that you know how important it is to have accurate and compliant billing and coding within your practice, you are probably wondering how to improve your current system. If your practice is struggling to reach compliance and fear you are not capturing the maxim reimbursement, the best possible solution is to hire a third party for revenue cycle management. Revenue cycle management improves the efficiency, accuracy, and reimbursements for medical practices. At Healthcare Information Services (HIS) our experts can take over the entire revenue cycle management process to take the burden off of our clients. Typically, HIS clients collect on average 10-15% more than their peers. Reliable revenue cycle management services improve practice efficiency and compliance, allowing your team to focus on providing superior medical care.

If your practice already has a billing team, then coding education may be the course of action for improving accuracy and compliance in billing and coding. By staying up to date on coding, your team can directly improve reimbursements and reap the benefits of compliant coding outlined above. HIS proudly offers a thorough coding education program to streamline your staff and boost revenue.

Accuracy and compliance in medical billing and coding are crucial for several reasons, impacting not only the financial health of healthcare providers but also patient care, legal obligations, and overall operational efficiency. Below are key points highlighting their importance:

1. Financial Impact

• Reimbursement: Accurate coding ensures that healthcare providers are reimbursed appropriately for the services they provide. Incorrect codes can lead to underpayment, delayed payments, or claim denials, affecting the revenue cycle of healthcare facilities.
• Prevention of Financial Loss: Billing and coding errors may result in lost revenue due to claim rejections or the need for re-submission. Inaccurate claims can also require costly audits or adjustments.
• Maximizing Insurance Payments: Correct coding ensures that the services are billed according to insurance guidelines, which is essential for maximizing reimbursements.

2. Compliance with Laws and Regulations

• Avoiding Legal Consequences: Healthcare providers are required to comply with federal and state regulations such as the Health Insurance Portability and Accountability Act (HIPAA), the False Claims Act, and the Affordable Care Act. Billing and coding inaccuracies can lead to violations of these laws, potentially resulting in fines, penalties, or even criminal charges.
• Minimizing Fraud Risk: Improper billing practices, such as upcoding (using more expensive codes than necessary) or unbundling (separating procedures that should be billed together), can be considered fraudulent. Adhering to compliance rules prevents the risk of fraudulent activity.

3. Quality of Patient Care

• Accurate Medical Records: Proper coding helps ensure that a patient’s medical records accurately reflect their conditions, procedures, and treatment plans. This is critical for continuity of care and for making informed clinical decisions.
• Improved Patient Outcomes: Accurate billing and coding ensure that patients receive the correct diagnosis-related services. It helps track patient progress, monitor for complications, and ensure they are receiving appropriate care.

4. Operational Efficiency

• Streamlining Workflow: Accurate coding helps improve the efficiency of healthcare operations by minimizing errors and reducing the need for rework. This frees up staff to focus on other essential tasks.
• Audit Preparedness: Compliance with billing and coding standards makes it easier to pass audits. Healthcare providers can avoid unnecessary audit-related delays, which can disrupt operations and strain resources.

5. Reputation Management

• Maintaining Trust: Accurate billing reflects professionalism and can foster trust between healthcare providers, patients, and insurance companies. Billing errors can damage the reputation of a provider and harm relationships with patients and insurers.
• Customer Satisfaction: Patients expect transparency and accuracy in billing. Errors in billing may lead to confusion or dissatisfaction, which can affect patient loyalty and lead to negative reviews.

6. Mitigating Risk of Denials and Appeals

• Reducing Denials: Proper coding reduces the chances of insurance denials. Accurate coding ensures that claims meet payer guidelines and are more likely to be accepted the first time.
• Minimizing the Need for Appeals: When claims are coded correctly, fewer appeals are needed to correct mistakes, saving time and resources.

7. Impact on Insurance Relationships

• Maintaining Positive Relations with Insurers: Insurance companies require healthcare providers to follow specific coding rules and guidelines. Compliance with these requirements fosters a positive relationship with insurers, ensuring smooth claims processing and minimizing disputes.

Conclusion

Maintaining accuracy and compliance in billing and coding is essential to ensure that healthcare providers are compensated fairly, maintain legal and ethical standards, and provide high-quality care. Errors in billing and coding can have significant financial, legal, operational, and reputational consequences, which is why healthcare organizations invest heavily in training, auditing, and compliance measures.