Are You Guilty of Undercoding?

It’s a dirty little secret in the medical industry that many physicians fail to get the maximum reimbursement on their medical billing claims because they undercode their medical billing claims. Doing this on a frequent basis can cause your practice to lose up to one quarter of your reimbursement revenue.

Undercoding also happens because the coding is left up to the staff in the office to perform and this method is guaranteed to have errors and omissions because the staff has no way of knowing exactly which services occurred in the exam room and which did not. Since notes don’t always get made at the time of the procedure, reimbursable procedures can be missed and many staff members will undercode the claim in order to insure they are well within the limits of reimbursable services.

In capitated care issues, a lot of money is lost by physicians who don’t code for supplies reimbursement on their medical billing claims. Worse, elective services and carve outs are miscoded and that causes the services to be bundled into the capitation rate which results in a lowered reimbursement rate for the physician.

One jaw-dropping example included an audit of a family physician’s records and his medical billing had over 70-percent errors in their coding on their medical billing. This resulted in a loss of nearly $185,000 for the practice. While your issues may not be that big in your medical billing, it can certainly get out of hand and any loss that could be prevented should be unacceptable. A recent statistic said all practices that do their own medical billing are losing about $10,000 per year on the average simply from undercoding on their medical billing claims.

If you have only been thinking about outsourcing your medical billing, look into it today, you can save your practice a lot of money and streamline your claims submission process and realize a greater profit for all your hard work! Work with your medical billing partner to get the maximum reimbursements for your medical billing. You deserve to be compensated for all your hard work – not just some of it.

View all Articles by: Kathryn E, CCS-P - Retired