Medical bills can cause confusion and stress. You expect to receive treatment from your doctor, but months later, you receive a bill that you didn’t expect and it causes great financial stress. Unfortunately, a simple error in how an insurance claim is billed or coded can result in denied insurance claims, confusion over how much you owe.
This is why medical billing and coding accuracy is much more important than most patients realize. Proper medical billing and coding protects both the healthcare provider and the patient’s financial health.
Here are seven reasons medical billing and coding accuracy prevents the accumulation of unnecessary medical debt and why it is so important:
- Decreases the Rate of Insurance Claim Denials
- Avoid Surprise Medical Bills
- Charge Patients the Correct Amount
- Expedite Payment for Claims
- Developing Transparency and Trust
- Assisting Patients With Appeals/Corrections
- Educating Patients About Their Healthcare Costs
One of the most significant reasons that patients accumulate medical debt is due toan insurer denying a claim. In many cases, the claim is denied because of an error in how the insurer processed the payment for treatment received. For example, if there is a missing modifier, an outdated code, or a discrepancy between a code and the actual services performed, then the insurer may deny payment for that claim.
When an insurer understands that there was a medical procedure performed and the medical necessity for that procedure, they are likely to approve that claim faster and with fewer additional requirements, thereby, preventing patients from being billed unnecessarily.
Most surprise bills arise from incorrect billing or being classified as out-of-network due to errors with submission codes. If services were billed accurately, then the patient would be less likely to receive a bill they did not expect or cannot afford.
If one of the codes associated with a patient is wrong, then the charges may be inflated. Because a patient’s actual medical bill should reflect only the care they received, it is critical for all code(s) associated to be correct and relevant.
Payment for healthcare claims can take weeks to months, depending on how much time it takes the insurance company to process them. If claims are submitted accurately, those payments will flow through their systems much quicker than incorrect submissions, resulting in overallshorter billing cycles. Patients can prepare for them much better.
When patients receive clear and detailed statements, they can understand their bills and feel less apprehensive and suspicious. By building a positive relationship between patients and providers based on transparency, it is much easier for patients to ask questions, obtain clarification, and set up a manageable payment plan before medical debts are incurred.
Issues can arise, even when the most sophisticated systems are used. Through proper documentation and the use of proper medical codes, patients can appeal to the insurance company to cover denied claims.
Therein lies therole for medical billing and coding specialists. They have the knowledge to correct errors, resubmit claims, and advocate for the correct amount to be reimbursed to the provider in order to avoid situations where patients are required to pay for costs that could be prevented.
When patients are able to obtain accurate medical bills, they can track their spending more closely and compare it to the insurance company’s Explanation of Benefits. Increased awareness helps patients make informed choices regarding their care, the expense of receiving care and their coverage through their insurance provider. This ultimately helps decrease the chances of patients accumulating medical bills that could later be considered asdebts.
Endnote
The accuracy of codes and proper claims submission leads to better communication with patients and less financial burden for them due to confusion about their medical costs and claims. In addition, the patient experience will also be enhanced, making sure that healthcare does not feel like an overwhelming financial burden.
When billing and coding are correct, the patient may experience a large financial burden due to unjustified denials, inflated charges or a lack of understanding regarding their bill. Accurate coding and billing will create an environment that allows patients and providers to better manage their healthcare costs and finances. In an environment where just a single mistake can have a long-lasting effect, accuracy is paramount.
