Using EHR Medical Coding Shortcuts May Put Physicians at Higher Audit Risk and Increase Billing Denials

Posted by Practice Management Institute on Nov 5, 2017 10:54:01 AM
Practice Management Institute

Medical coding errors can cause considerable damage to both patients and providers in the form of inaccurate medical bills and lost revenue for the medical office. The best practice is to employ well-trained and qualified staff to ensure that correct claims are submitted for reimbursement the first time.

If the devil is in the details, then physicians, their coding staff, and consumers are seeing lots of red these days. According to recent estimates, 75 – 80% of the medical bills healthcare consumers receive contain inaccurate charges that result from medical coding errors (1). Some studies point to Electronic Health Records (EHR) with automated features designed to ease coding complexity and help offices process claims faster. These shortcuts can lead to big problems for physicians, according to medical coding industry leader Practice Management Institute (PMI).

A recent study found that as many as 42% of claims submitted to Medicare were incorrectly coded (2). Not only can this be costly for consumers, these errors also negatively affect provider reimbursements and federally and state-funded healthcare programs.

"Employing well-trained staff responsible for the coding process is a must and can save big problems from cropping up down the line,” said David Womack, President and CEO of PMI. "It’s vitally important to ensure proper training for all medical staff involved in the medical coding process.”

Medical coding is a detailed, highly specific language with thousands of possible code combinations created to document an encounter. Coders need comprehensive training to perform at the level needed.

In many cases, physicians and coders use efficiency tools in electronic health record systems (EHR) to save time and increase productivity (3, 6). However, these coding tools from which they can copy and paste into EHR systems can lead to inaccurate documentation and charges for the patient (4, 6). By using shortcuts, untrained staff members may miss revenue opportunities for the practice and create a backlog of carrier denials (3).

The efficiency tools may also create a dangerous precedent when submitting inaccurate claims to Medicare. If an auditor finds problems with claims to Medicare, this profoundly increases a physician’s liability and could lead to fraud and abuse allegations (3, 5).

"Improper medical coding can have serious consequences for everyone involved in healthcare, from the patient to the provider," said Womack. A big part of the problem is that so many healthcare offices employ untrained, non-certified staff, left to figure out the coding system on their own. If medical offices want to avoid losing money and keep patients as safe as possible, they must invest in medical coding certification training for all their coding staff.”

It is vital that medical offices understand the importance of retaining staff that possesses an outpatient coding certification to help avoid coding mistakes. Because codes are updated yearly, employing certified medical coders helps protect both patients and providers against incorrect reimbursement and the potential for serious financial and punitive consequences if an auditor determines that reimbursements were incorrect and must be paid back.

About Practice Management Institute (PMI):

For more than 30 years, Practice Management Institute, also known as PMI, has helped physicians, hospital systems, medical societies, and educational institutions provide comprehensive education and training to medical office staff nationwide. By offering a variety of educational programs and professional certifications, PMI helps to build competency, compliance, and effectiveness that assures the continued success of their clients.

Since PMI’s formation in 1983, more than 20,000 individuals have earned certification in one or more areas of expertise. PMI is recognized by both the Centers for Medicare and Medicaid Services and the Department of Labor for training in medical coding, third-party billing, office management, and compliance. PMI training helps ease the burden of running a successful medical practice through thorough education and up-to-date training for non-clinical staff, allowing physicians to focus on patient care to improve the experience of the patient. For more information, visit

Subscribe Here!

Recent Posts

Posts by Tag

See all