Coding Myths May Place Physicians at Risk

Do you fully understand the coding and documentation guidelines? Nationwide studies suggest the answer to this question may be “no.” Common coding myths may be a contributing factor to revenue loss and risk of a formal audit in your practice. Here are four common myths:  

  1. Undercoding the level of service means a physician will not be audited.
  2. Receipt of insurance payment verifies that an encounter was coded correctly.
  3. A practice is protected against audits by not accepting Medicare patients.
  4. The target of audits is large group practices; small, solo practices will not be audited.

Inaccurate coding can signal the Centers for Medicare & Medicaid Services (CMS) about irregularities in a practice and may trigger a formal audit.  Because CMS uses profiling to identify practices for audits, if your coding varies from other physicians in your specialty, you will stand out.  The result may be recoupment of payment.

Contact TMA Practice Consulting at (800) 523-8766 or email practice.consulting@texmed.org for more information about our coding and documentation auditing and training services.

Published July 25, 2011


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