by Find-A-Code™
Apr 10th, 2024
Bias is a fascinating thing. It is present in all decisions human beings make. Unfortunately, bias is impossible to avoid one hundred percent of the time because the human brain is always influenced by external forces. Even in medical billing, bias is an issue that could probably stand to get a bit more attention.
The big question for medical billing specialists is how prevalent coder bias is. If its prevalence is significant, the next question to answer is how it impacts accurate billing. If it is not so prevalent, perhaps we don't have to worry about it all that much.
A Brief Description of Coder Bias
Coder bias in a medical billing scenario refers to the misinterpretations of clinical data during the coding process. It can be intentional or unintentional. The big issue with coder bias is that it can lead to coding and billing errors. It can also impact future patient care along with data collection and analysis.
Let us assume that most coder bias is unintentional. It happens at the subconscious level. What could cause it? Here are four possibilities:
- Demographics – How coders interpret demographic information could impact the chosen codes for a particular procedure or service. For example, a coder might subconsciously assign different codes to younger and older patients despite both receiving the exact same service.
- Lack of Information – To the extent that coder bias exists, one of the biggest causes is a lack of information in medical charts. When clinicians and receptionists don't provide complete information, coders are tempted to make assumptions.
- Lack of Training – A lack of training can contribute to coder bias by preventing a coder from fully grasping what it is they are doing. A lack of training could also lead to rushed coding practices among coders who don't want to fall behind. Rushing increases the risk of coder bias.
- Automation – Believe it or not, automation can introduce a certain level of coder bias via the natural bias of programmers writing algorithms. Algorithms can only do what they are programmed to do, even if their programming is biased.
As for how widespread coder bias is, no one really knows. Every medical coder or biller is subject to bias to one extent or another. But it is unclear whether natural bias is having a serious impact on medical billing accuracy.
Perceived Impacts of Bias
Knowing that some measure of bias is present in every human decision, what are the potential impacts of coder bias on medical billing? Improper reimbursements are at the top of the list. Coder bias could lead to either under- or over-billing for services. It could lead to healthcare providers not being fully reimbursed for the services rendered.
Care disparities are another concern. For example, under-coding a patient's condition could mean that person is not receiving an appropriate level of care. There could be additional problems down the road if a patient's insurance carrier will not approve additional treatments.
Coder bias probably impacts healthcare data accuracy. If the bias is minimal, data is more likely to be reliable. But if coder bias in a particular dataset is severe, the value of said data might be compromised.
Concerns about coder bias have increased in recent years. That is not because systemic changes have made it more possible. Rather, it is because we are learning more about how bias impacts decisions. Coder bias is a real thing just because all human decisions are biased. What we don't know is how prevalent it is and how serious its impact might be on medical billing.
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