Below, our professional biller and coders have provided some information about the benefits of outsourcing your medical billing and coding.

Medical Coding and Billing Services – Why Outsource?

One reason to outsource your medical coding and billing is that it frees you and your staff up to care for your patients.

When your staff are rushed because you’re clinic is busy or running behind, it is easy to make mistakes. Your patients will be taken care of more effectively at your practice with billing and coding taken off of your staff’s plate. Outsourcing this time critical solution to our certified medical billers and coders will be able to dedicate their time fully to coding and following up on unpaid claims, resulting in more claims being processed in a timely manner with fewer errors.

Accountability for Coding Errors

The CMS modify codes on a quarterly and annual basis. Incorrect coding, or miscoding, is likely for any medical practice that does not implement ongoing CPT code training for their medical coders.  Medical coding errors may lead to major delays in payment reimbursements and payer audits, which hurts your practice. Failure to provide correct coding can cause these payments to be delayed, denied, or limited.

MEREM Healthcare Solutions has found that an alarming majority of claims are rejected or denied upon initial submission. The reimbursement for denied claims depends on a practice’s efforts for correcting and resubmitting claim denials. You can avoid this problem by outsourcing your medical coding to certified professionals who have already become familiar with the new coding system and pursue ongoing training for relevant CPT code changes that directly affect our practice specialties.

When practices utilize outsourced medical coding solutions,

1. fewer mistakes are made
2. better care is given to patients
3. and billing cycles run smoothly.

Certified Coders Do More Than Just Submit Claims

It’s not uncommon for people to have multiple insurance companies. A professional, certified coder will make sure that each claim is submitted properly. Our expert coders have the correct software and expertise necessary to submit claims to all of the responsible payers while staying compliant with CMS and payer guidelines.

If any of your claims are denied, our billers can also handle the appeal process. Outsourcing your medical coding will ensure your revenue cycle is always running as smoothly as possible. (Did you know in-house medical coding costs more? Outsource!)

Ready to Outsource Your Medical Coding?

MEREM Healthcare Solutions, located in Birmingham, Alabama offers medical coding, billing, and revenue cycle management services to clients across the nation.

We are familiar with all of the ICD-10 and ongoing CPT changes upheld by CMS and MEREM Health will provide you with superior service for a fraction of the cost of our competitors! Contact MEREM Health today or request a FREE revenue cycle audit to find out how your medical coding can be enhanced with our dedicated expert medical coding team.

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Incorrect coding, or miscoding, is likely for any medical practice that does not implement ongoing CPT code training for their medical coders. It is important to understand the consequences of these coding errors and it may be a wise investment to consider outsourcing medical coding to an experienced service provider.

Coding Errors Impact Patient Care

It is the foundation of every practice to provide quality patient care. Inaccurate medical coding can interrupt that goal, leading to frustration and confusion and a potential breakdown of the relationship you have built with valued patients. Even though the consequences of incorrect coding rarely falls onto a patient, it does happen, and it is the most important consequence to try to prevent.

Failure to code correctly could directly impact a patient’s treatment.

A great example of this would be using an incorrect diagnostic code. Codes have slight variances between the specificity of a diagnosis. Inaccurate coding of the specifics during diagnosis could result in improper patient care at another practice, or for a particular service. A missing 2-digit modifier for a knee injury could result in having an MRI study conducted on the wrong knee. Or, imagine an incorrect diagnosis code causing an obstetrician to withhold pains medicine during a woman’s pregnancy. This would be an extreme case, but altogether terrifying and harmful for the patient.

If circumstances similar to the examples above have occurred in your practice, it may be time to consider outsourced medical coding in order to improve the accuracy of codes and prevent these serious mistakes from affecting your patients.

Outsourcing also frees up a great deal of time, allowing practitioners more time with patients. (Did you know in-house medical coding costs more? Outsource!)

Coding Errors Delay or Prevent Reimbursement

Medical coding is the life-blood of a practice. That is how the services you provide are transformed into billable revenue. Failure to provide correct coding can cause these payments to be delayed, denied, or limited. MEREM Healthcare Solutions has found that an alarming majority of claims are rejected or denied upon initial submission. The reimbursement for denied claims depends on a practice’s efforts for correcting and resubmitting claim denials.

A miscoded procedure’s reimbursement has the potential to differ by up to $15,000. Delayed reimbursements are also costly, as they are unexpected. A build-up of delayed reimbursements can cause a backup of paperwork, stress on your staff, overlooked coding errors, and even more incorrect coding to be filed resulting in loss of revenue for your practice.

This back up of denials due to coding errors requires focused efforts to catch up on claim denial and improve your revenue cycle. The healthcare revenue cycle/reimbursement cycle is a very particular machine.  All aspects need to work together just right and at the right time or the system breaks down.

Coding Errors May Lead to Fraud and Abuse Fines

As you can see, incorrect coding causes poor patient care and trouble with reimbursements, but what happens to those responsible? Practices and providers who have a history of coding mistakes may face fines and or federal penalties for fraud or abuse.

The False Claims Act (FCA) is the enforcement tool used for false claims. The consequences could be a monetary penalty or a legal issue if the claim is named fraudulent. To prove fraud occurred rather than abuse, the upcoding or miscoding of an event must occur over time and across a large number of patients.

We recommend all practices be proactive in monitoring their claim denials by setting Industry Benchmark Goals for our clients and by offering a complete Revenue Cycle Audit.

Understanding the Outcome of Outsourced Medical Coding

Medical coding can be an excessive amount of work, and small errors can cause significant harm. When practices outsource their medical coding, fewer mistakes are made, better care is given to patients, and billing cycles run smoothly.

Are your ready to improve your revenue cycle while avoiding the consequences of coding errors? Contact MEREM Health today to discuss outsourcing your medical coding.

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Spine and orthopedic surgery practices often face revenue building challenges due to billing and coding errors. The culprit is simply confusion in changes to procedure or misunderstanding of the strict guidelines and CPT coding criteria.

MEREM Healthcare Solutions offers insight for practice administration to improve their revenue through detailed coding and accuracy in the billing process. Providers must take ownership to analyze, investigate, and interpret the new coding changes as it will affect healthcare reimbursement and delivery moving forward.

3 Ways to Overcome Billing and Coding Reimbursement Loss for Orthopedic and Spinal Surgery Providers

1.  Understand and apply new CPT code changes for

a.  procedures such as bone grafting for aspiration only versus spinal arthrodesis.

b.  the growing number of medical devices used in spinal procedures and detail how and which are used for each procedure.

2.  Develop an overall understanding of higher payer scrutiny for procedures such as spinal discectomies.

3.  Provide detailed support documentation. The increasing complexity of shoulder procedure codes require support documentation about the type and number of parts of the shoulder involved in the procedure.

The coding team at Merem Healthcare Solutions is trained to help your practice maximize billed charges. By reviewing every encounter note and operative report, our specialty coders will prevent under-coding and over-coding to ensure that every billable procedure performed is correctly reported. Additionally, our consulting team can help you increase charges by maximizing your clinic output and improving documentation quality.

Healthcare economics, Medicare, reimbursement, spinal surgery

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