Is Your RCM Service Putting You at Risk of Overcoding?

As a medical practitioner, you know that it’s essential to manage your revenue as best as possible to maximize profit, but doing so should be done accurately, and with proper coding that matches services rendered. Overcoding, whether accidental or intentional, leads to an unwarranted increase in payment for your healthcare organization and raises red flags. 

While coding claims can be annoying, it’s a critical part of your revenue because these codes tell the insurance payer the nature of a patient’s visit and treatment method. It ensures they know how much to pay and that you actually get paid. Although billing mistakes (like incorrect coding) are common and easy for anyone to make on occasion, they can cause unnecessary trouble if they aren’t corrected. 

How Overcoding Can Hurt Your Business

Overcoding is a severe infraction that will put you at risk of an audit and potentially impact your revenue. Overcoding can happen in one of two ways: upcoding and unbundling. 

Upcoding refers to the act of submitting codes that are for more expensive treatment, resulting in a higher reimbursement. Unbundling is the act of billing services rendered as separate charges when practices usually bill them as a single charge.

These are both considered medical fraud and can trigger an audit at your hospital or practice. Overcoding and incorrect coding in general can lead to denied claims and time and effort spent correcting an unnecessary mistake, which doesn’t just hurt your patients, but also your organization in many ways. 

How Technology and Outsourcing Can Improve Your Practice

Thankfully, technology has come a long way over the years, and there’s technology available to ensure you’re not overcoding. Using computer-assisted coding technologies, you can quickly increase productivity and accuracy at your organization, leading to more claims collected, and fewer denials and errors. 

Automation for coding and outsourcing can significantly reduce the risk of errors in coding and other obstacles to receiving payment. Having a well-trained staff that is up to date on the latest codes and regulations is also vital to the continuing success of your practice.

A team or service that gives you confidence in your medical billing and coding allows you to focus on better care (which means happier patients and more revenue!). It’s truly a tool that works in your favor, and if you’ve yet to invest in proper RCM services, you’re missing out! 

Outsource Your RCM to a Medical Billing and Coding Service You Can Count On 

Overcoding can cost your practice thousands of dollars a year in denials, and even more if you’re penalized. Hiring a team of medical billing professionals is an effective way to keep your billing and coding on track so you can increase your revenue. 

At Ultimate Billing, we have a proven track record of getting results and performing all of the important tasks that other billing services don’t, like complete claims preparation and submission, denial management, and AR management. Upgrade your RCM today and set your organization up for success with our expert medical billing and coding services. To learn more, schedule a consultation with our team.

You might also enjoy