How does medical billing and coding maximize revenue for the healthcare industry?

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The United States healthcare system is an ever-changing marketplace. There are a lot of changes that occurred in its standard policies and regulations that have created new challenges for healthcare providers and patients alike. Many reforms of the healthcare system, like the introduction of more-time consuming, value-based consumption models and the frequent alteration of medical billing and coding regulations and policies stated by the US government can cause revenue losses for the healthcare providers across the country.

Therefore, it is the mandatory duty of medical billing and coding professionals to stay up-to-date with the amendments in the law and monitor real-time medical codes information to impact the healthcare industry and ensure maximum reimbursement.

How to Help Your Practice Over the Hurdle

Many tactics can lead the medical billing and coding professionals to mitigate the complications of the diversifying nature of medical codes. By adopting smart strategies and equipment medical billing and coding professionals can handle financial issues and compliance risks. Thus, medical billing and coding professionals can adopt a productive approach to assist healthcare in driving maximum revenue by ensuring proper reimbursement of their practices performed. 

1 Establish a Clear Collections Process:

All healthcare providers need to adopt a collections process to ensure financial progress and empowerment. They may opt for the assistance of offshore medical billing and coding companies to improve their revenue cycle management and receive maximum reimbursements of their practices.

Financial support and backend data repository are the two critical aspects of every industrial domain. Medical billing and coding professionals can provide robust financial support to the healthcare industry by executing the claim submission process with the help of smart tools and equipment to verify and remove errors and ensure reimbursement.

2 Manage Claims Properly:

Almost 80% of all medical bills contain errors and due to strict policies of health insurance companies; they result in claim denials. It thrives down the financial growth of the healthcare facility by decelerating the cycle of submission, rejection, editing, and resubmission. It makes the healthcare providers wait for months before receiving the actual payment of their practices.

It is essential to primarily prepare accurate claims and complete the requisites of the medical bills. It requires information that is accurate and real-time, therefore updated information and double-checking for any possible errors are necessary aspects of the claim submission process.

3 Minimize Coding Errors:

The medical coders describe the performed procedures using standardized codes within a claim, to make the claims submission procedure easier to decipher and process. These standardized codes can use  ICD-10-CM, CPT and HCPCS Level II classification systems.

It provides a standard procedure of describing medical codes for the services or therapies provided by the physician, which can help to claim their service charges from health insurance companies. The most common errors that might occur in these procedures include;

  • Incorrect information
  • Mismatched data
  • Missing codes
  • Misconception by clearing house

Non-specific diagnosis codes:

ICD-10 requirements for diagnosis documentation are much more explained than the previous ICD-9 requirements. These strict requirements create more complications in the medical billing and coding environment. It enforces the medical billing and coding professionals to capture updated information and monitor real-time data, this can often be accomplished by improving the quality of initial data collected about the patient from the referring physician.

Incorrect modifiers:

The second most significant reason behind the loss in revenue is the incorrect modifiers. In these cases, the incorrect modifiers are added to a claim or a required modifier for the denied or rejected the claim. These modifiers usually depend upon the requirements of the payer.


Upcoding is the problematic situation in the medical billing procedure in which adding or exchanging certain codes with the codes for more expensive procedures results in too many complications. It may happen as the result of miscommunication between the medical coder and the healthcare provider or it may happen unintentionally (which is illegal).

Under coding:

Under coding is the procedure of exchanging with a much less expensive code procedure. It may happen as a result of misconception during the communication between the medical coder and the healthcare provider, or it may happen due when a healthcare provider intentionally leaves out charges a procedure from a medical bill.

It is the best strategic move to double-check medical codes before submitting a claim. If a procedure code description is incorrect or ambiguous, then the front desk staff must concern contact with the medical billers and coders before assigning a code to avoid upcoding and under coding. If in doubt, cross-check with medical coding resources to ensure the accuracy of the medical code being used.

4 Regularly Handle Denied or Rejected Claims:

It is important to go through the significant difference between the denied claim and the rejected claim to better understand the collection management procedure.

Rejected claim:

A rejected claim is one that hasn’t been processed yet due to the existence of one or more errors. It prevents health insurance companies from paying the bills of the physician practices.

Denied claims:

It is a claim that the insurance company has processed and has deemed unplayable due to discovered violation of the payer-patient contract or some essential errors identified after processing. In both of these cases, the payer will return the claim to the medical biller with an explanation of the problem with the claim. A rejected claim can be corrected and resubmitted but denied claim must be appealed before resubmission, which is a much more expensive and time-consuming process.

It is important to identify and correct errors in a claim to minimize the occurrence of claim rejections and denials. Healthcare providers must keep up with the representative layer of health insurance companies. They can help to clarify problems with the original claim and provide real-time information for the claim submission procedure. All of this can assist to expedite the time consuming and difficult procedure of claim editing and minimize appeal and resubmission times. By following these guidelines, one can embed efficacy in collection management.

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