UnderCoding in Healthcare: What You Can Do to Avoid This Pitfall

Is your practice constantly faced with the problem of under-coding?

Undercoding in healthcare is defined as the process of medical coding wherein the codes used are not reflective of the full extent of treatment that the patient received. It is often the result of failing to abstract every code from the medical record or to select the highest specificity of codes. Like overcoding, it can lead to rejected or denied claims, not to mention decreased revenue. But under-coding can also lead to other, more serious problems, which is why it is crucial to avoid this mistake.

The Problem with Under-Coding

Despite resulting in lower revenues for practices, under-coding is still considered fraudulent and can lead to investigations or audits. Some coders think that under-coding is “playing it safe” when you’re unsure, but really it isn’t. It can be seen as inducement, or the practice of offering a free service to patients in order to encourage them to avail of a service that is covered by the insurance provider. This can lead to legal action on the grounds of fraud and abuse.

In healthcare undercoding should never be done on purpose as it is unethical if not illegal. When not done on purpose however it can still be problematic. This could be indicative of negligence, haphazard or lazy coding, and can lead to chronic under-coding, financial losses and improper patient care.

How to Avoid UnderCoding

Given the many problems that can arise from under-coding, it’s best to avoid it as much as possible. Here are some of the ways you can do that:

• Make sure your staff are properly trained. They should not only understand and use the proper codes but also not succumb to under-coding out of fear of claim rejection.
• Provide uniform coding for all patients. There should be a uniform code for both fully-insured patients and those who choose to pay in cash. Any discrepancy in codes for the same procedures between these two types of patients can be deemed discriminatory billing.
• Always stay updated on the latest codes to be used. Ideally, coding manuals should be updated yearly.
• Don’t get too familiar with a particular set of codes. Overusing the same set of codes can lead to undercoding, and all the problems that go with it.
• Be diligent in reading medical reports and double-checking codes. It may take a little more time, but double-checking is well worth it. It will save you from bigger, more costly problems in the future.
• Get the assistance of a professional medical billing company, such as Park Medical Billing. With Park Medical Billing you can be assured that billing errors will be minimized if not completely eliminated. We employ the latest and most trusted methods and technology to ensure that your billing goes as smoothly as possible, each and every time.

Maximize your billing and enhance revenue by avoiding pitfalls like under-coding. Get the expert help of Park Medical Billing. Get in touch with us today by calling 1-201-585-7306.