The subject of health is very personal. Doctor visits are a sign of a trust not only with the individual but with the establishment facilitating. Ensuring mistakes are not a part of practice in any capacity is of highest importance.
From large scale invoice to smaller scale appointment management, hospitals thrive on organization. While the field of medicine does enjoy consistent demand and revenue generation, poor internal management systems could minimize these benefits. Medical coding errors in particular could cost an organization finances, their reputation and even encourage judicial intervention.
Hospitals are high pressure environments. This forces patients, the establishment and, in some cases, insurance providers, to enter erroneous information or miss fields entirely. These missing pieces of information will cause complications going forward.
Some procedures normally share a bundling of codes. They are normally interconnected and this helps with categorization and maintaining simplicity. However, if separate codes are attached to each service individually, this is known as unbundling. This method could be employed by organizations to generate higher revenue from the same set of services. When the healthcare provider chooses to outsource medical coding services, they usually send in the medical charts, the diagnoses, and the prescriptions electronically to the medical coder or the medical coding agency they are working with.
Upcoding refers to attaching codes for more complicated and expensive procedures to the simple services performed. This is not limited to services or procedures but also testing. The intention of re-coding is to generate higher revenue through inflating prices and is illegal.
Under coding refers to attaching codes for simple and less expensive procedures to downplay the services rendered to the patient. This is normally done to assist a patient with lower costing or help with avoiding a need for an audit.
Pricing structures for medical services are slightly dynamic. If a medical professional is putting in more time and labor into achieving the initially discussed service, they must be compensated accordingly. However this leaves room for tampering. As a result, establishments are required to provide the proper paperwork for cost increases of standardized services to ensure no future issues arise.