SU_HCM1201_W2_Project_Sanders_A

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South University, Austin *

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2005

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Mechanical Engineering

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Feb 20, 2024

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Week 2 Project Austin “Blue” Sanders Professor David Witt HCM1201 South University 1/20/2024

Medical coding is a process utilized in the healthcare industry to describe a certain type of treatment or service. It involves transforming information related to a medical procedure or device into a unique alphanumeric code. This helps in the proper filing of claims with insurance companies. This essay aims to provide a comprehensive overview of the various complications associated with medical coding and billing. In addition, I'll talk about the advantages of utilizing technology in this process. Claims are often denied and delayed due to minor errors that have been made. Having the proper coding and billing procedures can help minimize the number of errors and ensure that your patients are happy. One of the most common reasons for delays and denials is the lack of data. One of the most common errors that can occur is the failure of the billing staff to link the diagnosis code to the Current Procedural Terminology (CPT) or Healthcare Common Procedure Coding System (HCPCS). Some of these errors can be caused by the employees, but it's also possible that the physician did not provide the correct diagnosis. Upcoding occurs when patients are billed for procedures that are more complicated than what they received. It could also be that the service was never provided to the patient. This could happen when the billing staff gets confused by the treatment codes and diagnosis given by the doctor. Due to the rise of healthcare technology, various issues have been reported in the billing and coding process. One of these is the

incorrect use of certain modifiers. Medical billers must determine which ones are used for real-time services and which ones are used for asynchronous communication. Another issue that can cause delays or denials is the failure to provide the correct information to the billing staff. This usually happens when the incorrect information is put on the patient. In most cases, this can be prevented by the staff going back and reviewing the data. A billing error can happen because of a slip-up by the employee. It could indicate that the staff member is not following the proper coding rules. To prevent this, make sure that the employees are educated about the billing process. Mishandling of claims can have a negative effect on a facility's operations. Inaccurate coding could lead to delays in payments or denials, which could cause the facility to lose revenue and experience additional stress. Claims have several steps before they are submitted. The information collected during the process is sent to various hands for processing. The information collected by a healthcare facility, such as the physician's diagnosis or input, the results of a test, the patient's information, and the insurance carrier's payment information, must be reviewed and finalized before a claim can be processed. There are various issues that can arise during this process. One of these is the manual entry of data. The process of collecting all the necessary documents and information can be very time- consuming and challenging. Another issue that can arise is if the data is processed

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digitally and if the software being used is not compliant. This can result in security threats. miscommunication can also occur when the information is sent back and forth. This method allows insurance companies to get a partial view of the patient's experience. Instead of the complete picture, they get fragments. Medical coding and billing have become more streamlined with the emergence of new technology. In the past, it was laborious to mail or email invoices, and now, with the help of electronic claims submission, coders can assign diagnosis and treatments codes with the help of software known as encoders. I came across PETTIGREW, an accredited company that provides an integrated system that helps with coding and billing. This can help with the timely collection of payments. In addition, they also offer remote coding and compliance services. Having the right software can help make the process run more smoothly. It takes information from a patient's symptoms and then turns it into an electronic code. This is then forwarded to the insurance company for reimbursement. An encoder is a type of software that makes coding easier and more user-friendly. It can also keep track of any updates to the codes. While coders have become more proficient in using electronic claims submission, they still need to be trained and experienced to process proper claims.

References: Nock, B. (2017, May 11). 5 Most Common Medical Billing and Coding Errors. Retrieved from Gabauer Company: https://www.gebauer.com/blog/medical-billing- and-coding-errors PETTIGREW. (2021, January 15). The Impact of Modern Technology on Medical Billing and Coding. Retrieved from PETTIGREW Healthcare Profitability Solutions. The Impact of Modern Technology on Medical Billing and Coding | PETTIGREW (pettigrewmedical.com) Zelinska, S. (2021, Aygyst 18). 4 Ways to Overcome Claims Challenges with Modern Tech Solutions. Retrieved from Empeek: https://empeek.com/4-ways-to- overcome-claims-challenges-withmodern-tech-solutions/