Not Coding to the Highest Level

This involves the process of abstracting the most information out of the medical reports completed by providers. This involves an in depth understanding of the medical terminology for both procedures and diagnoses. Coding to a general level, or under-coding commonly leads to rejected and denied claims.

NEXA’s Solution: A billing/coding software platform designed to automate the process of vital information being abstracted from medical reports in a consistent manner.

Bad Documentation/Missing Documentation

Of course, not coding to the highest level isn’t always the coder’s fault. In certain cases, the provider won’t give the coder enough information about the procedure they’ve performed. Providers may leave important details of the procedure out of the report, or they may provide illegible medical reports.

NEXA’s Solution: A billing/coding software platform designed with a built-in clinical data entry modality to allow data to be entered by the provider in a consistent manner per a given clinical scenario, minimizing the likelihood of missing or ineligible data

Lack of Access to the Provider

Ideally, every coder would be in constant contact with the provider they’re coding for. Unfortunately, that’s not always the case. Providers aren’t always available to consult on difficult-to-understand claims. Coders have to do the best with what they have in these situations, but still try and clarify the report as best as possible.

NEXA’s Solution: A billing/coding software platform designed to with a built-in clinical data entry modality to allow data to be entered by the provider in a uniform and consistent means in order to minimize the likelihood of difficult-to-understand claims

Failing To Use Current and Updated Code Sets

The organizations that maintain the three principal medical coding code sets (the WHO for ICD, the AMA for CPT, and the CMS for HCPCS) update these manuals yearly.

It is the responsibility of coders to learn any new or reorganized codes as they come out, and use them correctly. This is partly why professional organizations like the AAPC and AHIMA require every member to complete a certain amount of educational credits every two years. Keeping your skills sharp is imperative.

NEXA’s Solution: A billing/coding software platform designed with a built-in data base that has the capabilities for storage and updating as it regards the most current ICD, CPT, and HCPCS code sets for use

Under-Coding and Over-Coding

Under-coding is the purposeful reportage of less expensive medical services than were performed, while over-coding is the reportage of more expensive procedures than were performed. Both of these are fraudulent, and can lead to audits and investigations.

NEXA’s Solution: A billing/coding software platform designed to automate the process of all pertinent information being abstracted from medical reports in a manner where the level of coding consistently reflects the actual clinical encounter.

Unbundling

Like under- and over-coding, unbundling is not so much of an error as it is a fraudulent practice. Unbundling is closely related to up-coding, in that it involves false reporting designed to earn the provider a higher payout from a payer. Unbundling means separately coding procedures that would normally be included in one umbrella code.

NEXA’s Solution: A billing/coding software platform designed to automate the process of pertinent information being abstracted from medical reports in a consistent and uniform manner, whereas the rules that define bundled codes are established and written into the software itself, thereby eliminating the possibility of unbundling.

Medical Coding Errors

Given that the task of medical coding is highly detail-oriented, it is not uncommon at all for there to be errors made.

NEXA’s Solution: A billing/coding software platform designed to consistently capture all of the pertinent clinical data as entered by the provider that will be used to drive the automated billing claim in real-time.

Coder-To-Provider Communication

It’s not always possible for there to be frequent, real-time communication between the coder and the provider during the coding process, as for example, in many instances, coding has even been done by off-site coding agencies.

NEXA’s Solution: A billing/coding software platform designed with a built-in clinical data entry modality to allow data to be entered by the provider in a consistent manner per a given clinical scenario where then the billing claim is generated through automation