Some Common Compliance Pitfalls that Practices Should Avoid!

Posted by mgsionline on April 30th, 2013

The recent healthcare reforms like Patient Protection and Affordable Act and HIPAA 5010 electronic transition along with the upcoming ICD-10 Implementation have already kept healthcare practices and Hospitals busy in the past few months. During this crucial time period, it is highly essential that Healthcare Facilities and Providers take immense care in avoiding a few common compliance pitfalls that would badly affect their business, if overlooked. Let’s take a look at some common pitfalls that Practices should avoid,

Up-coding: It is highly advisable that Healthcare Facilities and Providers steer clear of up-coding. This major pitfall not only causes a huge revenue loss for the physician billing, but also defames the provider’s reputation. Up-coding, regarded as a fraudulent activity by the payers, is not an act of intention in most cases. It is caused by the so-called auto-coding tools in EHR systems. Though it saves time by generating codes automatically, one cannot completely rely on them without conducting proper audits. Therefore, providers must take additional care while performing medical billing and coding services, especially with the use of EHR systems. In this scenario, outsourcing medical billing services would be a good decision.

Mishaps in E&M Coding: A key challenge that Providers face is the E&M services that involve complicated coding strategies with levels of care. It is highly essential that a Provider’s medical record contains the three major components, Chief Compliant (CC) and History and Present Illness (HPI), Physical Exam (PE), and Medical Decision Making (MDM). If the medical record lacks proper documentation of any of these components, then the claims will not be paid by the payer. That being said, there is another complication involved in E&M coding. It is the levels of service pertaining to the three components. If a wrong level of service is coded, then the Provider is under the risk of being penalized. The best way to stay away from this tricky situation is to outsource medical billing services to a renowned medical billing company that understands the nuances of E&M medical billing and coding.

Billing Compliance: The frequent changes in the healthcare space is posing a great challenge to Providers. One of them is keeping track of the current compliance policies subject to medical billing and coding. Medical billing companies can do this job perfectly, so why not take their help?

Timely Appeals: Letting rejected claims pile up for later review and inflating the AR is the prime mistake committed by most Healthcare Providers. This pitfall can be avoided by outsourcing medical billing services to a reputed billing company. From accumulated AR cleanup to resubmission of claims, a medical billing company performs all services professionally, increasing your revenue.

About MGSI:

A good medical billing and coding company must provide all the above mentioned benefits apart from providing the best services! MGSI, a company with 20 years of service based in Tampa, Florida, is one such company that renders high-quality medical billing services to its clients.