by Gail I. Smith, MA, RHIA, CCS-P
I was leisurely reading my April edition of Real Simple magazine and came across an article called “Don’t Pay a Medical Bill Until You Do These 5 Things.” As a HIM practitioner and a coder of long-standing this, of course, sparked an interest.
The article summarized a list that included advice to research billing codes. The author of the article explained that every medical procedure has a corresponding billing code and if the wrong code was submitted, it may be the reason for a payment denial. A representative from the National Patient Advocate Foundation, who was interviewed for the article, recommended typing the code from the bill into a search tool like findacode.com and seeing if there is a potential error. The final step was to ask your insurer how a procedure needs to be coded to get covered.
Needless to say, this portion of the article caused me to pause. Encouraging patients to evaluate their codes is a major, complicated step for a layperson. How are they expected to translate complicated medical procedures and/or diagnoses into coded data? How would they understand coding guidelines that are essential to accurate and complete coding of a diagnosis or procedure?
It also caused concern about the quality of coded data. We all know that payment plans use codes to determine reimbursement, but who is standing up and supporting coded data for healthcare decisions, research, trending, etc.? This coded data that is so essential to public health, disease tracking, and analysis of healthcare services must be defended for the value of the coded data to be realized. If the only reason to assign a code is to get paid, then our structured data collection system is seriously flawed.
What is the answer? Frankly, I have no idea but an advocacy group that holds the flag for quality data comes to mind.
eLearning Library Subscription
Unlimited access to over 60 courses, assessments, and training curriculums designed to enhance job-specific, self-paced learning for one full year. Special pricing available for Groups. Train your entire team! Learn more here.