Tag: Coding Errors

claim denial management

Claim Denial Management: A Comprehensive Guide

Claim denials are a common challenge for healthcare organizations, often leading to significant revenue loss. While it’s impossible to eliminate denials entirely, proactive Claim denial management can significantly reduce their impact. Industry standards for claim denials are lacking, making it difficult to track and analyze denial trends. Each payer has its own unique policies and […]
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Prevent Coding and Billing Errors

Preventing coding and billing errors can reduce claims denials

Accurate medical coding and billing are essential components of a healthcare practice’s financial health. When codes for procedures and diagnoses are recorded correctly, providers can receive timely reimbursements for the services they deliver. However, Prevent coding and billing errors can lead to claim denials, delays in payments, and increased administrative burden This blog post will […]
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Benefits of Charge Capture audits

How Charge Capture Audits Boost Your Healthcare Revenue

The healthcare industry holds hidden potential for improved revenue and streamlined operations. Charge capture audits act as your key to unlock these hidden treasures. Similar to explorers seeking buried riches, healthcare organizations can embark on a quest for financial stability through these audits. This guide will explain charge capture audits, help you identify hidden opportunities, […]
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Advantages of Claim Scrubbing

Unveiling the Advantages of Claim Scrubbing

Claim scrubbing enables the potential for increased accuracy in claims, enhanced client relationships, and improved patient interactions. Claim scrubbing is the process of identifying and rectifying coding errors in medical claims prior to their submission to insurance providers. Whether conducted manually or through automated systems, claim scrubbers validate medical claims before they are sent to […]
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Benefits of Automated Medical Coding

How Automated Medical Coding Benefits Healthcare Sectors?

The relationship between medical coding and patient care may not initially appear connected, and they may even seem like complete opposites. While medical coding focuses on billing and revenue, patient care revolves around providing care to individuals. An from leading E-magazine’s recent article  emphasized this distinction, asserting that prioritizing care is essential over coding. However, […]
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medical necessity errors

Top Error Rates Offer Clues to Denials

The Comprehensive Error Rate Testing (CERT) program grew out of the Department of Health and Human Services Office of Inspector General improper payment rate estimates from 1996 through 2002. Due to sample size restrictions, the Centers for Medicare & Medicaid Services (CMS) assumed responsibility because they had access to more granulated data in 2003. The […]
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OB/GYN Coding

Correct Common OB/GYN Coding Mistakes

Overlooking separately billable services rendered during the global period will cost your practice dearly. Many obstetrics/gynecology (OB/GYN Coding) practices are coding deliveries incorrectly or failing to submit claims for “problem visits” during a prenatal or postpartum visit. Common mistakes such as these not only fail to capture payment for services rendered but also the meaningful […]
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Top 13 Reasons For Claim Denials

Top 13 Reasons For Claim Denials

Denied claims are one of physicians’ chief complaints when it comes to dealing with payers. To a certain extent, every practice deals with claim denials. It’s those practices that eliminate the most common reasons that experience a smoother revenue cycle and find greater financial success. Here are the 13 most common reasons for why claims […]
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ICD-10 Coding Errors, Diagnostic Errors, Payment Reform. Coding Errors

ICD-10, Diagnostic Errors & Payment Reforms to Improve Diagnostic Accuracy

In October 2015, physicians across the United States transitioned from the International Statistical Classification of Diseases and Related Health Problems, Ninth Revision to the tenth revision (ICD-10-CM, the US version of the World Health Organization [WHO] ICD-10). Although the ICD-10-CM was a new concept for physicians in the United States, the international variant has been available since […]
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“Defensive” Undercoding Is Indefensible

  Undercoding, or reporting a lesser service than was performed and documented, is sometimes employed as a defensive strategy to stave off claims denials or audits. But, undercoding can make a provider an outlier, and may create consequential patient care, compliance, and financial liabilities. For example: Undercoding Leaves Money On The Table, Driving Down Provider […]
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