Protect Yourself from Upcoding: A Physicians Guide to Accurate Coding

The medical documentation needed to support each patient visit can be overwhelming and rushing through the paperwork can lead to errors. Simple mistakes can lead to big consequences for physicians.

For billing and collections, coding a procedure at just one level below what it qualifies for can cause a loss of 20-30% for the physician. On the other hand, assigning a code that is one level above what is justified in the documentation is upcoding and results in overbilling and fraud. Proper revenue cycle management (RCM) with AQuity Solutions Physician Office Billing and Collections helps keep your code selection accurate, maximizing your justifiable billing and protecting you from trouble.

Mistakes are Easy to Make

Improper coding at any level hurts your business. If insurance agencies or Medicare detect reported severity levels outside of industry averages, it can trigger an audit. Whether it’s a new coder making rookie mistakes or a simple error in documentation, such audits can lead to serious consequences.

Violating the False Claims Act results in not only a lack of trust from payers and patients who may be subjected to increased out of pocket expenses, but also large penalties owed to the U.S. government. More than $5.6 billion was collected from providers due to such detected errors in fiscal year 2021.

AQuity Handles the Coding Level Balance for You

We know it can be a difficult tightrope to walk to make sure your documentation justifies the right amount without going over. As the physician, keeping up with those details and constantly changing rules fall on your shoulders. Whether a third party created the documentation, or you personally entered it directly into the EHR, the record is not finalized until you sign off on it, which in turn makes you 100% responsible for the accuracy of the charges. And with coding guidelines changing every year, it’s difficult to keep up while trying to stay focused on your patients.

Our dedicated account managers take control of your billing administration without any changes to your practice system or workflow, and our routine auditing provides education and analysis on where you might be losing out on money or where you could get you in trouble. By capturing these details and working with you, AQuity helps reduce coding errors and minimize denials.  Most of our private practice providers see a 10% increase in justifiable reimbursements.

It is possible to protect yourself from upcoding while improving patient satisfaction and properly capturing your maximum justifiable billing. Contact AQuity for complete outsourced Physician Office Billing and Collections Services for all specialties.

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