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You do not have access to this content. Denied claims may be appealed and reprocessed in certain cases. Healthcare providers are now in better control of their finances due to an efficient electronic billing system offered by medical billing companies. How Medical Billing Errors Negatively Affect a Practice - Amazing Charts The reasons for denial can include billing errors, missing information, inadequate patient coverage, and more. A simple slip of the fingers can result in the incorrect entry of a procedure code. Not only is it a significant source of revenue to practices, but it possesses an element of ethics, the case studys authors write. In certain cases, clear direction is stated that no modifier may be used to override the denial. Undercoding and overcoding- Undercoding is defined as the purposeful reportage of less expensive medical services than were actually performed. Consequences Of Inaccurate Coding And Incorrect Billing. We have a 99% success rate in overturning denials and collect 30% more for our clients, on average. Top 5 Things a Breast Reconstruction Patient Should Know/Do About Their Insurance Coverage: CLIENT QUESTION HOW TO PROTECT AGAINST POST OP PATIENT INSURANCE CLAIMS. Our team at DuvaSawko minimizes errors while maximizing reimbursements. Hand off this chore to the experts and youll decrease insurance denials and boost your cash flow. ICD-10 and CPT code manuals are updated annually. Not having an easy way to contact the health provider- Medical billing professionals should have easy access to the healthcare providers theyre doing work for. The severe consequences of incorrect coding can be prevented by: Hiring experienced medical billing and coding staff and training them regularly to keep their coding knowledge up to date. After all, without it, insurance companies would be unable to reimburse, reduce or approve claims. Thats why many groups outsource emergency department services. Submitting incorrect claims to the government (for Medicare or Medicaid) violates the Federal Civil False Claims Act (FCA). That junior partner is challenged with addressing the unethical and potentially illegal actions taken by a senior partner. Access reports from the Council on Medical Education presented during the AMA Annual and Interim Meetings. View the full case study in the AOAs EyeLearn: Professional Development Hub. Your emergency medicine group will notice a boost in revenue by following up on your medical denials. 2. when theres evidence of intentional misrepresentation over a long time and across a large number of patients. A rejected claim is one that contains one or many errors found before the claim is processed. Affects Reimbursement: Improper coding leads to improper billing, which can directly impact a clinic's bottom line. You can check out this guide created by the Center for Medicare & Medicaid Services to know more about the coding and billing information. All rights reserved. Repeated errors can trigger a coding compliance audit in which your organization is investigated for fraud.