Unlocking the Secrets to Accurate Medical Coding and Auditing: Insights from Our August Webinar

In our recent webinar, Advize had the pleasure of hosting Dena B. , a seasoned Healthcare Consultant with a wealth of experience in medical coding and auditing. Dena’s presentation provided invaluable insights into the roles of medical coders and auditors, the intricacies of these critical positions and the common pitfalls they face. If you missed the live event, don’t worry! You can now watch the full recording and download her slides [here].

Understanding the Roles: Coders vs. Auditors

The webinar delved into the distinct yet interconnected roles of medical coders and auditors. Medical coders are responsible for translating medical services into standardized codes, such as CPT? and ICD-10-CM, which are essential for billing and maintaining accurate patient records. Their work ensures that healthcare providers are reimbursed correctly, and that documentation is clear and compliant with legal standards.

On the other hand, medical auditors review and verify the accuracy and compliance of these codes. They act as a critical check and balance, identifying errors that could lead to financial losses or legal complications. Their role is vital in ensuring that coding is accurate and aligns with both payer requirements and regulatory guidelines.

Common Billing and Coding Errors: What to Watch For

During the webinar, Dena B. highlighted several common billing and coding errors that can lead to significant issues. These include:

• Duplicate Claim Submission: Submitting the same claim more than once can result in denials.
• Undocumented Services: Billing for services without proper documentation is a frequent error.
• Noncovered Services: Claiming services not covered by the payer can lead to denials.
• Medical Necessity Not Established: Billing for services deemed unnecessary by the payer is problematic.
• Unbundling of Services: Separately billing for procedures that should be covered under a single code.
• Incorrect Carrier: Submitting claims to the wrong insurance provider.
• Modifier Errors: Missing or incorrect modifiers can impact claim processing.
• Eligibility Issues: Claims can be denied due to incorrect beneficiary information or ineligibility.

The Impact of Audits on Compliance and Revenue Integrity

Audits play a crucial role in maintaining compliance and ensuring revenue integrity. They come in two main forms:

• Prospective Audits: Conducted before claims submission to catch errors early.
• Retrospective Audits: Performed after claims processing to identify and correct mistakes.

These audits help healthcare organizations comply with laws and regulations such as #HIPAA and CMS guidelines, prevent costly errors like upcoding or undercoding, and protect providers from external audits and investigations by identifying potential issues internally.

Why Partner with Advize ?

Partnering with Advize offers so many benefits:

• Proactive Risk Management: Our audits identify potential hazards, vulnerabilities, and gaps in clinical processes and workflows.
• Enhanced Provider Education: We offer crucial internal compliance tools that contribute to patient safety and regulatory compliance.
• Continuous Improvement: Our services support ongoing improvement of healthcare processes and outcomes.

Without the expertise of a dedicated partner like Advize, healthcare organizations risk maintaining the status quo, which can conceal significant risks. Our objective audits and compliance consulting ensure that you are not only meeting current standards but also improving continuously.

For those who missed the live webinar or want to revisit the valuable information shared, you can watch the recording and download the slides [here]. Don’t miss this opportunity to enhance your understanding of medical coding and auditing.

By Dena B.