Why Incorrect Medical Coding Can Cause Huge Issues

Why Incorrect Medical Coding Can Cause Huge Issues

If you’re not familiar with the medical system, then you might be blissfully unaware of how important medical coding is and what kind of implications it can have for your practice if your coding is not correct. These implications can trickle down to impact your client, as well as sabotaging the care they get as well as their relationship with your practice. Keep reading to learn the top three consequences of incorrect medical coding and their implications.

Impacting the Quality of Care Your Patients Receive

Most practices are client focused and strive to provide the absolute best quality of care to their patients. Incorrect medical coding can directly impact the patient clinic relationship in a variety of ways. First and foremost incorrect medical coding can impact how much reimbursement your patients receive, directly impacting their finances. Using an inaccurate code during any stage of the medical journey from diagnosis, testing and treatment can result in treatment that doesn’t line up with the actual condition and is instead based on the wrong medical code. This can result in delays in patient care, reductions in patient reimbursement and even reduced overall care. If you’d like some help minimizing the likelihood of coding errors, get the CDI Pocket Guide. Most patients won’t be on the look out for incorrect medical coding so it is our responsibility as providers to ensure accurate coding is used.

Coding Errors Impacting Reimbursement
Because insurance reimbursement is based on the diagnosis received and recorded in codes, having incorrect codes can impact how much reimbursement is received. It can result in overpayment, not enough being paid, and even claims being outright denied. This can directly impact your patient’s finances and how much medical care they may be able to access in future. Correcting these mistakes can be a lengthy and expensive process, and in many cases the errors won’t be corrected, meaning your patient suffers.

Risk of Triggering Abuse or Fraud Claims
Whether intentional or accidental, a series of incorrect submissions of claims with incorrect medical coding can result in penalties. There’s a specific act, called the False Claims Act which is dedicated to managing this problem. Under this act the ramifications for incorrect medical claims can be either financial or legal consequences. Even if the medical coding mistakes were genuine mistakes, repeated mistakes can trigger ramifications that can impact your business and reputation.

As you can see there are consequences for not only your practice when things are incorrectly coded, but for your patients too. It can impact their finances, the quality of care they receive, and even what medical treatment they can have in future for this specific illness or injury. For this reason it’s imperative that you ensure your practice has accurate medical coding practices that allow you to be confident that you’re using the right codes for each and every patient.