Substandard Coding Causes Revenue Loss

March 30, 2023 Brian Keller0
Substandard coding causes revenue loss
When it comes to medical coding, healthcare providers often miss out on how important it is for the long-term sustainability of the institution. Medical coding can be considered one of the most important components of the medical billing process. It is the accuracy behind medical coding that ensures that a healthcare provider gets paid for the services it delivers to the patients. While on the other hand, Incorrect or wrong coding in medical billing can result in claim denials, delayed payments, and other legal issues. Thus, it becomes important to understand the impact of wrong coding versus right coding in medical billing.
Wrong Coding in Medical Billing
The impact of wrong medical coding can be huge on healthcare providers, some of the most common effects of wrong coding include the following: 
Higher Claim Denials: Incorrect coding can lead to claim denials, which means that healthcare providers will not get paid for the services they have provided to the patients. This can be a significant financial burden on healthcare providers, leading to reduced revenues and cash flow.
Reduced Payments Percentage: At times insurance companies may not pay the full amount for a claim if the coding is incorrect, leading to reduced revenues for healthcare providers.
Compliance Issues: Legal problems for healthcare providers due to wrong coding can lead to fines, penalties, and even the loss of a healthcare provider’s license.
Addition in Administrative Costs: Due to denied claims, healthcare providers may need to spend more time and resources appealing the decision or correcting the coding. This can lead to increased administrative costs, reducing the profitability of healthcare providers.
Right Coding in Medical Billing
In contrast to wrong coding, right coding can have a positive impact on medical billing. Following are some of the ways in which the right coding can impact healthcare providers:
Improved Claim Acceptance: When coding is accurate, claims are more likely to be accepted by insurance companies. This can lead to faster payments and improved cash flow for healthcare providers.
Correct Reimbursement: By implementing the right coding process, healthcare providers can receive the correct reimbursement for the services they provide. This will lead to improved financial stability and profitability for healthcare providers.
Improved Compliance: Having the right coding process in place can help healthcare providers comply with all relevant regulations and requirements. 
Reduced Administrative Costs: When coding is correct, healthcare providers can avoid the time and resources required to appeal denied claims or correct coding errors. 



How Outsourcing Medical Coding Can Help Healthcare Institutions Improve Coding accuracy in Several Ways?
Instant Access to Expertise: Outsourcing the medical coding process can allow healthcare institutions to access a team of experts who are knowledgeable and experienced in medical coding, billing, compliance, etc. These experts have up-to-date knowledge of industry standards, regulatory requirements, and coding guidelines, and can help ensure that the healthcare institution’s coding is accurate and compliant.
Improved Coding Accuracy: Improvement in coding accuracy can be achieved by utilizing experienced coders who have a thorough understanding of ICD-10, CPT, and HCPCS coding. These coders can review documentation and ensure that diagnoses and procedures are accurately coded, resulting in fewer denials and improved cash flow.
Increased Compliance: Complex regulatory requirements, such as HIPAA, HITECH, and the Affordable Care Act can be complied with by the healthcare institution if the billing process is outsourced to an RCM partner such as CIVXDATA. Coding providers can monitor compliance and ensure that coding practices are in line with regulations, reducing the risk of audits and penalties.
Cost Savings: Outsourcing can eliminate the need to hire and train coding staff, invest in expensive coding software, and keep up with changing coding regulations. Additionally, outsourcing can help reduce denials and rejections, resulting in faster payments and increased revenue.
Overall, outsourcing medical coding to a specialized business partner can help healthcare institutions improve coding accuracy, increase compliance, and save costs, which can lead to improved patient care and financial stability.
Want to get assistance in understanding the benefits of our Medical Coding solutions? Get in touch here.

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