Medical Billing and Coding IssuesWhen you work in the medical field, it is important to be ready and willing to keep learning throughout your career. This holds true for doctors, specialists and staff who work with clinical coding optimization. The healthcare industry is constantly changing, the recent ICD-10 changes, changes that have come with the onset of the Affordable Healthcare Act, and other sweeping changes have greatly affected medical billing services in otolaryngology and across the board. Healthcare consulting companies provide valuable services to ENT practices and clinics, including education, training, and support to help keep the business side of your medical practice healthy and productive.

However, there are five common issues that frequently plague today’s medical practices. Once you learn what they are and work with healthcare consulting companies like MD Pro Solutions to gain the tools that will help you overcome them, you can move past them and keep your team on the right path. Knowing what your job is, being able to do your job to the highest level, and having professional practices in place that help you maintain that level of excellence is what every clinical coding optimization team and team member needs. Through training, online support, testing and audits, MD Pro Solutions can help you to get on track and stay on track with your medical billing services.

  • Outdated Procedures – If your team is not up-to-date on the latest requirements for clinical coding optimization, they are not coding to the highest level of specificity. What that means is that they don’t have a grasp on the medical terminology for procedures and diagnoses, as required with the latest ICD-10 changes. It also means that they are unable to continue coding to an expected level to maintain proper claims submission and collections. This can lead to denied or rejected claims, resulting in a loss of income for your practice.
  • Bad Medical Reports – In some situations, the problem lies not with the inability of the medical billing services department to correctly understand the proper procedures and diagnoses that were given to the patients, but in the actual medical reports themselves. Some physicians leave out essential details that could assist in more accurate coding or pass on illegible reports, which can lead to coding mistakes. When providers are busy and unable to communicate effectively with billing staff to properly identify clinical coding optimization issues, it can lead to increased problems and rejected or denied claims.
  • Outdated Codes – There are three primary medical coding sets that are updated annually. Coders need to stay up on any changes to codes so they will be able to use them correctly. Providing your medical billing services team with education, training, and support through trusted healthcare consulting companies like MD Pro Solutions can help them to overcome issues that are plaguing other practices throughout the industry. Preparing and training staff for big changes, such as the recent ICD-10 changes, will help them to stay better equipped to handle other sweeping changes to the healthcare industry and keep your practice running smoothly.
  • Under and Over-Coding – There are problems with both of these issues throughout medical billing services across the healthcare industry. Under-coding is when practices purposefully report that less expensive medical services were performed. Over-coding is the opposite, it is when practices purposefully report that more expensive medical practices were performed. While these are not considered to be errors or mistakes, because they are purposefully done, they are still things that should be addressed and overcome through proper training for clinical coding optimization.
  • Unbundling – While this practice is similar to over-coding or upcoding, it is even more fraudulent and damaging. Unbundling is when false reporting is done in order to increase a higher payout from the payer by separately coding various procedures that would normally be added once in a single overall code. Healthcare consulting companies can work with you and your medical billing services department to ensure that this type of fraudulent practice is not happening and will not happen in the future.

What You Can Do to Make Improvements
As a practice owner or manager, there are things that you can do today to make a change. Whether you have already experienced rejections and denials of claims, or if you just feel that your medical billing services department is overwhelmed, there are professional services and support that can get you back on track. Stay diligent with your team to make sure that they are fully versed and knowledgeable in healthcare industry regulations, such as the ICD-10 changes. Ensure that they are diligent and detail-oriented by communicating with them often about how things are going with clinical coding optimization. The provider should be available to realistically answer questions about medical reports, procedures, and diagnoses to assist in proper coding for medical billing services.

Keep your team on their toes by working with healthcare consulting companies to provide regular testing, review, support, education and training. This will help your staff to stay up-to-date with the latest changes to avoid claims rejections or denials. MD Pro Solutions believes that education and training is the key to your practice’s success. Our team of experts are trained and experienced in otolaryngology management, billing, and coding. We can help you and your staff to survive all of the constant changes that occur in the medical billing services industry. Give us a call at 508-946-1665 for a FREE consultation or for more information about our professional ENT focused services and solutions.