Relying on outdated coding guidance, using vague documentation that's useless to coders and unintentionally downcoding are among the nine ways in which medical practices and physicians undermine their own reimbursement, according to a report in Physicians Practice online.
Consider this: The average billing error rate for general practices is a whopping 27 percent. That translates into a three to 15 percent loss in annual revenue, according to the April issue of HFM magazine. While it's unlikely you can immediately address every issue that siphons this money away from your practice, taking steps to correct the nine billing blunders outlined by Physicians Practice seems like a good place to start. Among them:
Unintentionally downcoding follow-up visits for established patients. Physicians often downplay the services provided and don't adequately describe the time they spent with the patient, the article points out.
Using nearly identical documentation for each patient. Red flags shoot up among auditors and payers when physicians use the same wording in every patient's medical record.
Skipping internal audits. At a minimum, practices should review at least five notes each year for government payers, or select and review 10 notes at random, according to the Physicians Practice report. Of course, your audit is only as good as the follow-up actions you take.
Got a partner who doesn't take audit findings seriously? "Try extrapolating the results of your small-scale audit to a full year of income lost by undercoding or gained inappropriately by overcoding," the article recommends. "After all, that's similar to the way the feds figure fines for overcoding."
For more information:
- read the Physicians Practice article
- check out the April issue of HFM (reg. req.)
- heed these billing audit tips from the AMA