With the increasing need of healthcare facilities, clinics, and other centers to deal with patient billing and claim information, there are high chances of making mistakes. Even though you will work with industry experts in coding and auditing services, generating flawless audits and coding records needs a lot of caution and attention. Most times, these mistakes are quite paltry and meager. But they can cost you thousands of dollars, if not millions.
Owing to this reason, we have briefly explained some of the top errors in medical record audit and coding services that you shouldn’t ignore.
Incorrect patient information
If the patient information, like the name, date of birth, date of diagnosis, consulting professional, medical history, and more are updated incorrectly, it will cause errors in the audit reports. Also, billing can’t be done with complete accuracy which will put you in a tough situation, especially if this continues to happen for multiple patients.
Uploading incorrect diagnosis and treatment codes
Let’s say a patient has opted for treatment type ‘A1A’ and you have mistakenly updated his/her record as ‘A1B’ or ‘A1’ only. In this case, not only the specific codes will be missing from the data block but also the record won’t match with the billing paper. This can put the authenticity and genuineness of the medical coding services at risk. Therefore, one needs to be extremely aware of the type of treatment availed, and their respective codes, especially the updated ones.
Updating wrong procedural codes
Many procedures may give similar results or might be based on the use of similar equipment but you cannot combine them. Even if there is one point of difference between these procedures, a specific code needs to be assigned to them. If you do not follow the codes or update the generic ones, the insurer won’t process the claim and also, the audit reports will have discrepancies.
Entering bundled codes in medical record audit
One of the main mistakes that a professional can make during medical coding services is entering bundled codes in the audits. As a coder, you need to categorize the health treatments, medicines, and procedures with multiple codes. However, when a patient has opted for a specific treatment or medicine that is not used frequently, you have to include unbundled codes that will specify the process clearly. Failure to do so will lead to denied claim requests on behalf of the insurer.
Misinterpreting the medical and diagnosis reports
To enter the right codes in accordance with the medical treatments availed and the diagnosis reports, one needs to understand the documents and everything associated with the same. If you are unable to understand anything or misinterpret the report, the codes won’t be as expected. Therefore, the payer will deny the claim request due to your failure of understanding the medical reports.
No knowledge about updated reference codes
When a healthcare facility includes new treatment lines or changes priority codes of different procedures, the reference codes are updated. If you don’t have any knowledge regarding the same, you will refer to the old ones which have been made obsolete and redundant. This will introduce errors in the medical audit and billing reports and the claim request will become invalid.
Presence of duplicate data sets
Sometimes, duplicate data sets are present in the database for several attributes, starting with patient records to procedural information. These can cause discrepancies in the audits, thereby increasing the chances of submitting wrong reports to the insurer. As a result, the claims will be denied immediately and you may have to deal with legal issues due to felony and fraudulent audit works.
Awareness and patience are the only ways to avoid mistakes
These mistakes are meager and usually happen due to lack of knowledge, impatient behavior, and misinterpretation of documents. Therefore, to reduce errors in medical record audits, you need to be aware of the codes, how to disintegrate them into specific batches, and patiently update all information, be it about the patient or the treatment.
