Healthcare providers undoubtedly work in a fast-paced environment with little margin for error, so it’s no surprise that accuracy is the name of the game when it comes to your medical coding and billing processes.

Ultimately, inaccurate medical coding has serious implications for the financial and long-term success of your medical practice, affecting smaller practice owners the most due to a lack of resources.

1. Reimbursement Uncertainty

Providing quality patient care and running a healthcare organization is hard enough work, so submitting a claim really shouldn’t be something you have to waste time on; it should be a straightforward process.

However, as you’ll know, improper coding and billing can quickly turn insurance claim submission into a game of roulette. When your claims are full of medical coding errors, you generally stand a much lower chance of receiving reimbursement on time, receiving denied claims in its place.

The patient’s insurance company tends to meticulously review all the claims they receive, and even minor inaccuracies you weren’t expecting can trigger rejections and force you back to square one.

Some of these consequences extend even further beyond financial strain, too, with your practice’s cash flow taking a knock and affecting your ability to cover expenses or invest in any necessary resources.

Moreover, all the time and effort maintaining a correct coding process and constantly correcting errors for resubmission ultimately diverts your practice’s resources away from patient care and administrative tasks.

2. Struggling With Stability

Generally speaking, inaccurate coding leads to incorrect patient care, which is a quick way to throw your practice’s financial stability into disarray.

Lost revenue and decreased profitability become persistent challenges, having to constantly go back and forth with insurance companies about minute details and nuances. This issue is only exacerbated if you’re not outsourcing to medical billing companies to handle your coding and claims processing.

3. Uninvited Audits With Serious Consequences

Naturally, no one wants an auditor poking around their place of work, regardless of what industry they work in. Still, more often than not, auditors are triggered by coding and billing errors.

It goes without saying that audits disrupt most of your daily operations, consuming valuable time and possibly even resulting in fines or penalties if they manage to uncover any significant compliance violations.

They’re actually more than just a nuisance, too; they can have serious consequences for the livelihood of your practice – again, especially if you’re a smaller practice with fewer resources to make a case for yourself.

Non-compliance with all the relevant Current Procedural Terminology (CPT) codes commonly causes financial penalties, not to mention some of the reputational damage or even legal action in some cases.

As for your practice, the stress of undergoing an audit is never good for the overall harmony of your practice and causes unnecessary strain for you and your staff, too.

4. Compliance Quicksand: Navigating Ethical & Legal Challenges

Aside from all the financial turmoil, inaccurate coding and billing practices can also trap your practice in a long and incredibly convoluted web of legal challenges.

As with the auditors, regulatory bodies closely monitor medical practices so they can ensure they remain compliant with all the relevant guidelines. So, when inaccuracies occur, it generally raises red flags and even triggers investigations.

5. A Drain on Resources & Staff Morale

Inaccurate billing opens the door for further operational inefficiencies, generally speaking. Think of all the time your staff spend rectifying coding errors and appealing denials – compliance issues too.

Naturally, this is a stressful and unwelcome experience for all your staff, with overworked physicians possibly leading to reduced quality in patient care.

6. Missed Opportunities Preventing Scaling Opportunities

Within all areas of practice management, flawed coding and billing practices can actually inadvertently stifle any potential for growth and scalability as you’re constantly fighting an uphill battle to break even.

Naturally, your practice is going to miss a lot of chances to expand and ultimately flourish by overlooking some of the more crucial aspects of coding and billing.

7. Jeopardizing Patient Relationships

Understandably so, patients like transparency when it comes to their medical bills, so when they encounter errors or discrepancies, doubts are going to creep in.

Next, they could start to wonder if maybe this same lack of attention to detail applies to their medical treatments, creating a slight trust deficit that puts patient relationships at risk.

How Outsourcing Can Help

For every healthcare provider, mitigating some of the challenges associated with inaccurate coding and billing is absolutely vital for your success.

If your practice is based in California and you find yourself struggling with some of the complexities of the billing process, consider outsourcing to PMN!

PMN has over 20+ years of expertise in all areas of medical billing, from urgent care to pain management services. If you’d like to hear more details on how PMN can reshape your practices and billing procedures, get in touch today at (949) 215-5055 or by visiting their office in Laguna Hills, Orange County, California!

FAQs

What Should I Do If I Receive An Audit Notice?

Firstly, try to stay calm and gather all relevant documentation. Go through the audit notice thoroughly and consult an experienced healthcare attorney or coding specialist if you’re going to need some guidance. Make sure you respond to the audit within the designated timeframe and provide accurate information and supporting documentation whenever you can.

Can Outsourcing Coding & Billing Help Reduce Errors?

Absolutely, largely because specialized coding and billing companies have the skill-set and the dedicated resources to ensure accuracy for your practice, however, make sure you choose a reputable partner and establish clear expectations, maintaining regular communication so you can safeguard your practice’s interests.