The Risks of Undercoding
When considering audit results, a good number of compliance experts, providers, and coders are concerned about “over-coding,” or reporting a service or procedure not adequately backed up by documentation. Even though over-coding is obviously a problem—and one that can get you into serious problem—that doesn’t mean you’re playing it safe by intentionally undercoding, or reporting a lower-level service than is backed up by documentation.
At the moment, you are probably asking: “What’s the problem with undercoding? You might even think you are economizing Medicare program money by billing lower levels of services.
CERT is an approach of inappropriate payments. The aim of CMS and Novitas is to pay claims that meet Medicare’s needs and pay them at the proper level of service, should there be an underpayment on account of under coding, claims would not be paid correctly which would be counted as an improper payment error. Undercoding errors can statistically affect computed error rates in tens of millions of dollars. Under-coding also has negative effect on patients and the data that Medicare as well as other payers employ to calculate payments.
Undercoding misrepresents the accurate level care that is given to Medicare beneficiaries. These statistics are employed to calculate future Medicare payments and monitor trends in healthcare delivery. Patterns of undercoding are usually seen as aberrant and open medical practice marketing up to audits and reviews. Additionally, undercoding affects practice revenue. Check out what we offer at Med billing services.
In most cases you are not going to be properly paid for the level of service you offer to your patients and Rectifying undercoded claims means costly appeals.
Undercoding is not any approach to compliance—in reality, it is a compliance risk. Practices should really make an effort to report services at the level supported by provider documentation, or what Novitas refers to as right coding. When you practice right coding, coding the level of service supported by your documentation, everyone wins – you, your patients and the Medicare program.
Why do practices undercode?
There are numerous reasons your practice may be undercoding. It might come from an office assistant’s failure to read the doctor’s notes correctly. It could be done deliberately to help out patients who are unable to afford the fee for the more expensive procedure. Oftentimes, providers particularly undercode out of fear, they plan to avoid audits at any cost. Some might think by Under-coding they are flying under the radar. However this is absolutely not true. Our medical billing agency in USA helps health-care business with under-coding.
Undercoding is an unwise move to make and it can backfire.
For instance, a practitioner who routinely undercodes might be more likely for an audit when their services suddenly falls below industry average. The route to prevent denials is to ensure proper documentation. You might be putting your practice at risk when you are under-coding patient visits and your patient need more intensive treatment in the future, you will be questioned for not documenting exact data of the treatments initially.
Finally, it is essential to note, that the increase in high deductible health plans is creating a greater percentage of patient-owed responsibility in your revenue mix implying that the days of assisting patients by not billing them have come to an end and your practice can definitely not afford to offer free services.