Now Enrolling for Summer and Fall 2024 Semester 

6 of the Worst Medical Billing Mistakes You Can Make

1. Not Updating Your Knowledge of Coding Guidelines

One of the most common mistakes medical coders make is failing to stay up-to-date on coding guidelines. The guidelines are constantly changing, so it's essential to stay on top of them. The best way to do this is to read coding publications and attend coding seminars on a regular basis.

2. Coding Too Generically

 Another mistake medical coders often make is coding too generically. When you're assigned a code, it's important to take the time to review all of the available options and choose the one that best describes the patient's condition. Don't just choose the first code that comes to mind; take the time to find the most specific code possible.

3. Not Understanding How Modifiers Work

 Modifiers are an important part of medical coding, but they're often misunderstood. A modifier is a two-digit code that provides additional information about a procedure or service. Modifiers are used to indicate that a procedure was performed on a different body part than usual or that it was performed by a different provider than usual.

4. Overlooking Exceptions

 When reviewing a patient's chart, it's important to look for any exceptions that may apply. An exception is a condition that alters the way a procedure or service is coded. For example, if a patient has diabetes, this will usually result in a higher level of care and therefore a higher reimbursement rate.

5. Forgetting about Bundling Rules

 Bundling rules are another common pitfall for medical coders. Bundling rules dictate which procedures and services can be reported together and which must be reported separately. These rules vary from payer to payer, so it's important to be familiar with the bundling rules of every payer you work with.

6 .Not Using Resources Properly

 There are many great resources available to help medical coders do their job more effectively; however, not all coders take advantage of these resources. The Centers for Medicare & Medicaid Services (CMS) website is a great resource for finding information on coding guidelines and payment policies. Other helpful resources include the American Medical Association (AMA) website and coding manuals from major coding organizations such as the American Health Information Management Association (AHIMA) and American Academy of Professional Coders (AAPC).

Serious Consequences

Medical billing mistakes can have serious consequences—for both patients and providers alike—so it's essential that medical coders do everything they can to avoid them. By staying up-to-date on coding guidelines, being specific when assigning codes, understanding how modifiers work, looking for exceptions, familiarizing themselves with bundling rules, and taking advantage of available resources, medical coders can help ensure that patients receive the care they need and providers get reimbursed for their services.