For small to midsized medical offices struggling to get by, educating staff about proper coding is often low on the list of spending priorities. But failing to do so may be contributing to their downfall, experts say, as coding mistakes are a major source of lost revenue.
"Most small offices don't do audits and have no idea that they're doing anything wrong and losing potential revenue," says Lynn M. Anderanin, senior director of coding, compliance, and education for consulting firm Healthcare Information Services in Park Ridge, Ill.
Anderanin says she routinely finds the same errors repeated when auditing her clients' charts and reviewing their procedures. Many stem from a lack of education about the latest coding additions and changes, leading to misuse of modifiers and coding at the wrong service level. Another big problem is lack of staff dedicated to following up on denials.
"Practices miss revenue when the billing staff doesn't correct and resubmit denied claims," says Nancy M. Enos, coding consultant for the Medical Group Management Association and a coding instructor for the American Association of Professional Coders (AAPC). "And if the back office doesn't tell the front office what mistakes they're making, they won't be able to correct them and learn from them."
Anderanin, Enos, and other experts weighed in on some of the most common coding mistakes they see everyday leading to lost revenue. Most can be avoided, they say, through educating staff and devoting resources to fixing the problems that cause claims to be denied.
The potential for error begins as soon as a patient walks through the door, with registration and insurance verification. Inaccurate personal or insurance information recorded at the front desk leads to a significant number of denied claims, says Enos.
In busy small practices, front office staff may simply copy the patient's insurance card without taking the time to verify that she is still covered under that plan, Enos says. Other common errors include recording incorrect policy numbers, failing to authorize services, and entering the wrong name, address, guarantor, and even gender.
"If you write down the patient's name as 'Skip Brown' because that's what they told you — but the insurer only knows 'Walter Brown' — then they're not going to pay that claim," she says.
Patients sometimes unknowingly submit the wrong insurance information, says Anderanin. For example, Medicare patients who enrolled in the Medicare Advantage Program might submit their old Medicare card and assume it's the same program, but Medicare Advantage operates independently from traditional Medicare.
If staff fails to verify the Medicare card, the claim gets sent to the wrong place and the office doesn't get paid until it is sent back, corrected, and resubmitted, she says.
"You can document the right procedure and code the right way, but if you send it to the wrong insurer it won't get paid," says Raemarie Jimenez, who manages the clinical development of AAPC's exam program and oversees development of content for its coding certification exam. She recommends always asking the patient a direct question ("What is your insurance?") as opposed to whether anything has changed since their last visit (they'll usually say "no"). Then verify the information online.