If the devil is in the details, then physicians, their coding staff, and consumers are seeing lots of red these days. According to recent estimates, 75 – 80% of the medical bills healthcare consumers receive contain inaccurate charges that result from medical coding errors⁽¹⁾. Some studies point to Electronic Health Records (EHR) with automated features designed to ease coding complexity and help offices process claims faster. These shortcuts can lead to big problems for physicians, according to medical coding industry leader Practice Management Institute (www.pmimd.com/) (PMI).

A recent study found that as many as 42% of claims submitted to Medicare were incorrectly coded⁽²⁾. Not only can this be costly for consumers, these errors also negatively affect provider reimbursements and federally and state-funded healthcare programs.

“Employing well-trained staff responsible for the coding process is a must and can save big problems from cropping up down the line,” said David Womack, President and CEO of PMI. “It’s vitally important to ensure proper training for all medical staff involved in the medical coding process.”

Medical coding is a detailed, highly specific language with thousands of possible code combinations created to document an encounter. Coders need comprehensive training to perform at the level needed.

In many cases, physicians and coders use efficiency tools in electronic health record systems (EHR) to save time and increase productivity^{(3, 6)}. However, these coding tools from which they can copy and paste into EHR systems can lead to inaccurate documentation and charges for the patient^{(4, 6)}. By using shortcuts, untrained staff members may miss revenue opportunities for the practice and create a backlog of carrier denials⁽³⁾.

The efficiency tools may may also create a dangerous precedent when submitting inaccurate claims to Medicare. If an auditor finds problems with claims to Medicare, this profoundly increases a physician’s liability and could lead to fraud and abuse allegations ^{(3, 5)}. 

David Womack, President and CEO of PMI, says, “Improper medical coding can have serious consequences for everyone involved in healthcare, from the patient to the provider. A big part of the problem is that so many healthcare offices employ untrained, non-certified staff, left to figure out the coding system on their own. If medical offices want to avoid losing money and keep patients as safe as possible, they must invest in medical coding certification (www.pmimd.com/certify/default.asp) training for all their coding staff.”

It is vital that medical offices understand the importance of retaining staff that possess an outpatient coding certification (www.pmimd.com/certify/certified-medical-coder-certification.asp to help avoid coding mistakes. Because codes are updated yearly, employing certified medical coders helps protect both patients and providers against incorrect reimbursement and the potential for serious financial and punitive consequences if an auditor determines that reimbursements were incorrect and must be paid back.

Sources:

1. It’s Time to Get a Second Opinion Before Paying That Medical Bill. NBC News. http://www.nbcnews.com/business/consumer/it-s-time-get-second-opinion-paying-medical-bill-n545626
2. Significant Medicare coding errors signal need for physician education, OIG says. Medical Economics. http://medicaleconomics.modernmedicine.com/medical-economics/content/tags/coding/significant-medicare-coding-errors-signal-need-physician-educa?page=full
3. Chapman S. Beware of Poor Coding Habits. For The Record. 2014;26:20. http://www.fortherecordmag.com/archives/0114p20.shtml
4. Electronic Health Records: The Good, the Bad and the Ugly. Becker’s Health IT & CIO Review. http://www.beckershospitalreview.com/healthcare-information-technology/electronic-health-records-the-good-the-bad-and-the-ugly.html
5. How EHR Documentation Can Become a Liability. Physicians Practice. http://www.physicianspractice.com/blog/how-ehr-documentation-can-become-liability
6. It’s time to get doctors out of EHR data entry. Medical Economics. http://medicaleconomics.modernmedicine.com/medical-economics/news/its-time-get-doctors-out-ehr-data-entry?page=0,0