According to the American medical association, medical coding errors can be classified as abuse or even fraud. The word “Abuse” itself is used to mean the mistake made in coding. But even if classified as a mistake, the consequences that they entail are severe. Simultaneously, the fraud is used to mean that efforts were there consciously to increase profit fraudulently.
According to them, generating and using CPT codes and billing can be regarded as a very complicated process and varies from patient to patient. The process also varies from company to company and from procedure to procedure. It means that no two cases are going to be the same.
You’ll find that even some of the best financial services can get their claims denied. Some of the mistakes that the insurance companies commonly make can help you better deal with them. These errors related to billing, coding, and errors related to filing are taken from actual claims filed and, thus, are a practical illustration of the commonly made mistakes.
If You Need Help with Your Medical Bills, You Should Read the Following:
1. Coding That Doesn’t Point to a Procedure Specifically:
For every diagnosis, coding must get done till the highest level is reached for that particular code. This means including the most number of digits that can be useful for a particular code. If you want an example,
In the case of ICD-9 essential hypertension can be noted as “malignant,” “benign,” or “unspecified” using the following codes respectively, “401.0”, “401.1”, and “401.9”. “170” is the code in the case of ICD-10. Primary hypertension in the case of ICD-9,401.0 will include high blood pressure, but if you don’t have a hypertension diagnosis, high blood pressure will not get included. You’ll find that this is denoted in the case of ICD-10 with R03.0.
In the case of ICD-9, diabetes can be denoted by 250.0. The digit that can be found in the fifth position is the type of diabetes the person has. The code is E10.649 in the case of ICD-10.
If any information is not provided, it may result in the insurance company’s claim getting rejected. Some of the things missed out in most cases of claims filing are when the incident first happened, the accident occurred, the Date when the patient was brought to the emergency room, and the Date from which the illness started happening.
You should pay close attention to the claims papers that were filed and see if any fields are blank or left unfilled. You should also make sure that all the information supporting the claim is provided, including supporting documents.
3. Not Filing the Claim on Time:
A claim may get rejected if you submit it outside the time limit set for filing the claim. It might happen even if there’s nothing wrong with the claim that you’ve failed. The Affordable Care Act makes it mandatory to submit claims within 12 months. It was set at 15 to 27 months before. The date put on them from the date in the claims form of the Medicare claim will be considered the date from which services started.
The Medicare claims form has to be submitted within 12 months of the receipt of service. Any claims submitted outside that window will not be considered, and the person to whom the claim has to be submitted should be a claims processing contractor. Any claim that the contractor receives after 12 months is liable to be denied.
You should understand that documents supporting the performed procedures are useful in claiming the reimbursed amount.
You’ll find that for commercial insurances, the time within which a claim is to be submitted will differ from that mandated by Medicare.
4 Wrong Information about the Patient’s Identity:
To make sure that this error doesn’t happen, you should make sure that the spelling of the patient’s name in the claims form is accurate. There should also be no discrepancies in the sex and date of birth’ of the patient. It also should be made sure that a valid policy number is entered. You should also check if there is any error in denoting the patient’s relationship in question with the insured person. The next thing that should be checked is whether the CPT code matches the patient’s procedures.
These are some of the information that you should make sure are accurate when filing for claims. For any assistance in this regard, you can consider reaching out to ClaimMedic. They’ll be able to help you with any medical billing disputes that you want to raise.