Practice’s Spotlight: The Significance of Medical Coding


The Healthcare industry is witnessing changes that will be impactful for the future. These changes include the transition to telehealth services that might serve in the better future also. One more change is the decline in revenue due to the pandemic. So, to get out of this impactful situation it’s important to improvise proper strategies in all your services. One leading area to focus on is medical coding.

Medical coding serves as an intermediate between the payer and provider. As it describes the service carried by providers that includes diagnosis and treatments, they are considered as hotspot area to incorporate innovative ideas to get maximum reimbursements. Even the smallest mistake in your coding can make you lose more revenue or providers might have been paying for the service they rendered. Thus, finding and effectively reducing them is equally important for every practice.

Read through the article and get insights on the mistakes that need to be avoided. Coding is also considered to be followed with standard procedures but making new tactics and understanding it to improvise the work is always welcoming.

Stay updated with regulations

For some it might be not a center of focus thinking coding is not going to make changes in your revenue outcome. But this is a misconception, it does affect your revenue. Many providers miss their revenue opportunities by not knowing themselves.

One major reason is by under coding, that under-defines your practice services which eventually leads to low payments. Thus, working on providing correct codes is important that reduces missed payment opportunities.

One way you can achieve this is by learning and reviewing regulatory rules that are being updated very often. You can make use of information and policies that are available on the websites of the Center for Medicare & Medicaid Services (CMS), and the American Medical Association (AMA). Updating yourself with changing policies nationally and locally is the solution to escape from making errors in your coding services.

Quality payment program that affects the codes

Many providers are failing to be aware of the Merit-Based Incentive Payment System (MIPS), which needs to be clarified to many Medicare providers. It assigns quality scores for a provider that equally affects your reimbursements. So if you are a Medicare provider you must also be aware of one more thing that is the factor that determines your score.

Taking into consideration the scores assigned are taking account of claims. Appropriate usage of coding is required by providers for getting maximum scores that directly influence the value of your reimbursement.

Innovation with codes for better value

With the coordination and guidance by AMA, providers can also suggest changes to the government with the change of codes. Where new modifiers and codes are added to make information clear. This enables to provide more accurate information about services rendered by physicians.

Move for an analytical approach

With the availability of digitalization in hand, there is this option for providers to periodically update their information. This very idea will help coders to verify and identify claims that are denied and now reworked from the provider’s side. This will effectively improve the workflow share between different domains of healthcare.

Medical coding and mistakes

As mentioned above the significance proves that Medical coding is an indispensable criterion to look upon when you face a reduction in your reimbursements or there are obstacles in obtaining the payments. Have you ever solved solutions in mathematics with the wrong formula? You might get some results but not the right answer. Similar will what happens in your coding services. Medical coding needs to be done precisely. You might write some codes but may not get effective reimbursements.

Keep an eye on the below mentioned mistakes that are being done by many practices:

The fear of denials

Inclusion or omissions will what comes to your mind in case of errors but one of the major coding errors done by many providers is “under coding”. Medical codes are structured and they are specific to each diagnosis and treatment. There is always this fear of being denied with claims in the provider’s mind this very idea makes them under code.

Loses you’re facing with under coding

You are voluntarily forfeiting your reimbursements for your services by under coding. The five-digit codes will explain and define your practice service to patients. For example, some patients visit your practice services frequently; if you provide a code with 99201 instead of 99215 to these established patients, you make incorrect claims. This would eventually result in your claim being denied or receiving less money than you needed.

As a result, you must identify and analyses claims that are under-coded by you. Yes, over-coding the same can result in claim denials. So, make sure of using appropriate codes.

Services that are not covered with billable codes

The demand for all claims to be submitted digitally and the use of systematic platforms for electronic health records is also raising worries and questions among providers. So, if you have platform-related questions, ask your advancedmd EHR software providers and double-check them with updated codes on a regular basis.

Many providers have expressed concern that not all services are set as billable codes in their platforms, limiting their ability to provide accurate codes for their services. For example, services provided with injections and other medications, as well as dose variations, are not classified appropriately with codes that result in lower payments for your services.

Confusions with codes

One common mistake that still needs to be addressed is the use of old codes and another common silly mistake is, that what is described in the documentation will differ from the codes. When you send the same for billing this will eventually lead to denial.

The next confusion and negligence are with the use of modifiers. They are used to give additional information about the services with medical coding. But with a lack of awareness, many are not using these codes with their services which directly causes missed revenues.

Precise in clinical documentation

With the recent trend in changing medical codes, it’s also eminent to be aware of them. As they provide clear information about services and diagnosis. With the up gradation of new codes of ICD-10, we can have improved details about diagnosing. With the changing needs, there is also this mere responsibility for providers to properly make the clinical documentation. This is what explains your service clearly thus providers at any chance should not make mistakes.

Be aware of Medicare rules

Another area in which providers fall short is being unaware of their Medicare patients. It’s important to ensure getting payments without providing services free of cost.

Also, Medicare rules may differ locally thus knowing exactly what your area covers is equally important. As with examining your patient’s health, the same care should be taken to examine the rules and what your patients’ Medicare plans cover. 

Bottom line

With emergence of pandemic, many providers faced shrinkages in, it’s important to get profit wherever possible and try to improve technological advancements for better workflow. Restructuring medical coding domain is important for achieving improvements in your revenue cycle management.

You can also investigate errors in your ongoing medical coding services by identifying and analyzing your practice services, as well as educating the bottlenecks that are interfering with effective coding practice.


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