Make sure you’re down with down coding
Posted On March 23, 2012 By Advance Blog
Imagine that you are a handyman. What you charge is based on the type of job that you execute. So let’s say that building a deck will cost $2,500, and installing shelving will cost $200. You wouldn’t want to be paid $200 for building a deck that should cost $2,500 would you? Of course not!
Evaluation/Management codes (E/M codes) determine how much the insurance companies will be billed for office-related visits. A common practice among physicians who use paper charts is down coding. Down coding is the use of a lower billing code, rather than the use of a more accurate code for fear of an audit. According to the 1986 False Claims Act (FCA), those charged with fraud may be assessed fines of $5,500 to $11,000 per claim.
Physicians tend to be cautious in their coding, and in turn, lose an average of $40,000 annually, according to Medical Economics Magazine. Think about that for a second…physicians are afraid to claim $40,000 that they deserve, for fear of an audit. The problem is not the physicians or the auditors. It’s the accuracy of the coding that’s to blame.
Electronic Health Records (EHR) can increase revenues by using system recommended E/M billing codes, based on the services that were provided. It is then up to the doctor to proceed with the suggestion, or enter a code manually. By following the recommended codes, physicians can be consistent with their coding and more confident that they are claiming the appropriate amount of earned revenue.
If a physician who employs an EHR system is audited, he/she can go right to the EHR to show that the coding is compliant with the documentation in the EHR. More accurate coding will speed up the reimbursement process, which will result in fewer rejected claims. The cleaner that the claims are being submitted, the less claims will be rejected.
It doesn’t make sense to lose $40,000/year and to be at risk of audit…not when the technology is available to prevent it. EHR’s empower physicians to code with confidence and to maximize their claims.