decisionhealth Newsletters, Part B News - 2023 Issue 5 (May)
Find expert tips to dodge real-time CPT coding and billing errors
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Article Overview
This article reviews common CPT and ICD-10-CM billing and coding errors, explains why claims get denied, and outlines broad strategies practices can use to reduce revenue loss. It is aimed at coders, billers, compliance staff, and physician practice administrators who need a current, practical overview of documentation, claim submission, and payer-edit issues. The discussion also touches on E/M code updates, fraud and abuse concerns, and general workflow improvements such as claim scrubbing, technology, and outsourcing.
Why This Topic Matters
Coding and billing mistakes can delay payment, increase denials, and create compliance risk. Understanding the main categories of errors and the broader update landscape helps practices protect revenue and improve claim accuracy.
Article Sections
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Billing
An introductory section that frames the article’s focus on revenue cycle management, coding accuracy, and common billing problems in physician practices.
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What role does medical coding play in health care?
A general explanation of how coding supports payment for diagnostic and procedural services and why errors can affect claims and reimbursement.
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Assess damage from inaccurate coding and billing
A high-level discussion of compliance risk, including fraud and abuse concepts and the financial consequences of inaccurate claims.
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Keeping up with code updates
A discussion of recent and ongoing updates affecting evaluation and management coding, documentation standards, and broader coding workflow changes.
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Payers reject claims for many reasons
An overview of common causes of denials and the role of appeals, reprocessing, coding accuracy, and claim review in resolving them.
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How to reduce the effects of coding errors
Practical, non-code-specific strategies for reducing errors through claim processes, staying current with guidance, technology, and outsourcing.
What You Will Learn
- How coding and billing errors can affect claims and revenue cycle performance
- Why recent evaluation and management updates matter to physician practices
- Common sources of claim denials and the general ways practices respond to them
- Broad categories of coding and billing mistakes to watch for
- Workflow approaches that may help reduce claim errors before submission
Who Should Read This
- Medical coders
- Medical billers
- Compliance staff
- Physician practice administrators
- Revenue cycle management teams
Codes Discussed
Code Ranges Discussed
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