Medical Coding Errors

1. ELIMINATING HUMAN ERRORS IN MEDICAL CODING
Prepared for
Paul Sager, Instructor
Written Communications: 70402
Fox Valley Technical College
Prepared by
Sharon A Nemecek, Student
Health Information Technology
Fox Valley Technical Student
August 3, 2016

2. August 3, 2016
Professor Paul Sager, Instructor
Fox Valley Technical College
Written Communication
1825 N Bluemound Drive
Appleton, WI 54912-2277
Dear Mr. Sager:
Enclosed is the report you requested on Eliminating Human Errors in Medical Billing for Written
Communication. This report covers the problems encountered in the billing of services in the
medical field. With a customer’s account information being handled by so many departments;
the chance of errors increases.
This report highlights some of the areas where errors occur on patients’ accounts. It suggests
ways these errors might be reduced. It also shows how important internal audits can be by
bringing light to areas where changes in billing procedures need to be made. It will highlight
some of the most common errors made when handling medical accounts. Audits will also help
medical facilities fromavoiding possible payer audits. The report also emphasizes the benefits
of continued education for all employees. Understanding the correct procedures and policies
that are set in place will help in avoiding some serious mistakes.
I am grateful to the Teaching and Learning Center for their knowledge and assistance in helping
me set up this report with the correct structure and guidelines.
After reviewing this report, if you have any further questions, please contact me at
nemecek0613@fvtc.edu. It would be my pleasure to discuss any additional information you
may need.
Sincerely,
Sharon A Nemecek
Sharon A.Nemecek
Student, Fox Valley Technical College

3. Student, Fox Valley Technical College
TABLE OF CONTENTS
EXECUTIVE SUMMARY iv
Purposes of the Report iv
Eliminating Human Errors in Medical Billing iv
Recommendations iv
INTRODUCTION 1
Background 1
Purpose of the Report1
Significance 1
DISCUSSION OF FINDINGS
How do medical coders play an important role in healthcare compliance 2
What is the importance of internal audits 2
How do monitoring and auditing claims improve revenue and prevent costly errors 3
What are some of the benefits of electronic health records 5
What are some of the liabilities of electronic health records 5
How important is teaching coding to medical students 6
How important is the continuous training of medical staff regarding compliance 6
Conclusion(s) 7
References 8
LIST OF FIGURES

4. Figure 1 Percentage of Errors 4
Figure 2 Percentage by Provider 4
EXECUTIVE SUMMARY
Purposes of the Report
The purpose of this recommendation report is to determine ways that errors in medical billing
accounts can be reduced. Topics that were examined to determine the best procedures to
assist in billing errors include: the value of medical coders in healthcare compliance, the
importance of internal audits, how monitoring and auditing claims improve revenue and
prevent costly errors, the benefits and liabilities of electronic health records. Other areas
addressed were the importance of teaching coding to medical students and the importance of
continuous training for all medical staff regarding compliance.
Eliminating human errors in medical billing
This research determined that medical facilities need to be vigilant in addressing problems with
medical billing. It shows how audits and training are important to find and fix errors in billing.
Recommendations
The recommendations of this report include using internal audits to address any problems and
deficiencies in billing at medical facilities. Using ongoing training for all medical staff, especially
medical coders. Have meetings with staff to inform them of any policy changes or
discrepancies found. Have policies in place that follow state and federal regulations regarding
compliance. Have security measures in place to ensure that medical records are protected.

5. Eliminating Human Errors in Medical Billing
introduction
Within the medical field there are many instances where the medical record can be incorrect.
Many people touch the patient’s record before it is submitted to the insurance company. If
information is not correct when it is submitted, it could cause denied claims.
How do medical coders play an important role in healthcare compliance?
What is the importance of internal audits?
How do Monitoring and Auditing Claims Improve Revenue and Prevent Costly Errors?
What are some of the benefits of electronic medical records?
What are some of the liabilities of Electronic Health Records?
How important is teaching coding to medical students?
How important is the continuous training of medical staff regarding compliance?
Background of Topic
There are many places that mistakes can be made regarding a patient’s bill during a hospital
stay. Many people take part in the process of creating the bill from admission through
discharge. A common error in medical billing happens when inaccurate information is
submitted when a patient checks in; such as, the incorrect spelling of the patient’s name or
submitting the wrong insurance information. If the notations of the doctor are not clear, the
patient’s account may not be coded correctly and could lead to the patient being charged for
the wrong procedure or level of care. Some of the other billing issues are: duplicate charges,
being charged for a cancelled test or procedure, charges that should be billed together that are
billed separately, getting billed out-of-network charges when it should be in-network, incorrect
quantities because the wrong number was submitted, and coding errors. Making these errors
contributes to incorrect or non-payment of claims.
Purpose of the Report
Dedicated employees work hard to make sure that the patient’s billing account is as accurate as
possible; however, the need to eliminate human error is essential to proper insurance payment

6. and customer satisfaction. Finding ways to reduce errors on the patient’s account is the reason
for this report.
Significance
It is important that a patient’s charges are correctly submitted to the insurance company so the
claimis paid.
FINDINGS
How Do Medical Coders Play an Important Role in Healthcare Compliance?
Stegman (2005) contends, with so many regulations and changes in policies regarding medical
billing and coding, it can be very confusing keeping on top of all the changes. Coders are
responsible for staying updated on the latest information related to their field (Ossoff, Braswell,
& Raborn, 2012). Doctors are extremely busy and do not have time to worry about billing or
coding problems. They rely on the medical coders to be responsible for determining that the
codes submitted with the insurance claim are accurate (Adams, Norman, & Burroughs, 2002).
For a provider to be reimbursed for services, the claim needs to be submitted to the insurance
company. It is very important that the coding is accurate when the claimis submitted or it will
be denied. Medical Coders are trained to determine the correct codes needed so the claim is
processed correctly and the provider reimbursed. Besides training, the coder is licensed
through their state and also receives education in other medical training as well as other
related training that can help them do their job better (Ossoff, Braswell, & Raborn, 2012).
What is the Importance of Internal Audits?
Allen (2016) believes hospitals would help themselves by using internal audits to find areas
where there are inadequacies in their billing procedures. Being proactive by discovering
problems and fixing them will allow claims to be paid in a timely manner. A facility that does
have routine audits as part of their policy might have a better chance of avoiding payer audits.
More federal agencies and insurance companies have been requesting payer audits. Therefore,
it would be in a hospital’s best interest to do their own internal audit to ensure that their
facility has proper safeguards in place to prevent errors on patients’ accounts.
One of the areas in an internal audit that should be emphasized is the correctness of the
medical coding. This is important to assure proper payment from insurance companies. Every
department should be audited to make sure adequate procedures are in place. There are so
many ways that a patient’s medical record can have incorrect information. There needs to be
clear policies in place to prevent and handle errors (Allen, 2016).

7. Different departments need to share information and work together to make sure any issues
that arise can be dealt with immediately (Allen, 2016).
Software programs can be set up which could identify possible problems and errors. One way
this could be done would be by monitoring coders to find specific common errors being made.
It might identify areas where information is needed for verification purposes. Any employer
who is making the same mistakes would be taught the correct procedure (Allen, (2016).
Internal audits are an important learning tool to confirm any problems employees might be
experiencing while doing their job and help them gain knowledge of the correct procedures
they should be following (Allen, 2016).
How do Monitoring and Auditing Claims Improve Revenue and Prevent Costly Errors?
Kusserow (2014) points out that government agencies are very proactive in monitoring medical
facilities to make sure the claims are valid and processed correctly. Every part of the claimmay
be scrutinized. With the introduction of ICD-10 there will probably be a greater emphasis on
inspecting medical facilities processes for submitting claims.
These checks and balances could be a benefit to the medical industry. If they become aware of
any deficiencies in their processing of claims and are able to correct the problem, it will allow a
smoother processing of medical claims. Claims being processed proficiently will allow quicker
payment from insurance companies. Auditing claims and finding errors will allow the facilities
to make the needed corrections so the claim can be processed quicker (Kusserow, 2014).
Kusserow (2014) asserts that compliance officers will want to verify whether all areas of the
medical facility interact well with each other. They will try to determine if there are any specific
problems that need to be addressed. The location should also be aware of any new procedures
and government regulations that need to be enforced. Coders should be up to date in all new
procedures and regulations. They also want to make sure that there is ongoing training of
employees so they are aware of any new processes or the retraining of any procedures that
need to be addressed. The compliance officers would also want to make sure that the facility
has their own audits in place to catch any problems that may arise.
The following charts show some of the common mistakes that could cause non-payment or
improper payment of claims. Figure 1 shows the percentage of common medical billing errors.
Figure 2 shows the type of providers surveyed. This audit was a government audit from “Office
of the Inspector General” of the “Health Care Financing Administration” (Prophet & Hammen,
1998). The research is from 1998, but the information should still be relevant (Prophet &
Hammen, 1998).

8. Figure Reason for Denied Claims
Figure Type of Provider
(Prophet, 1998)
What Are Some of the Benefits of Electronic Health Records?
Electronic health records allow all departments the opportunity to access a patient’s medical
record. It is a valuable resource for the provider to have the ability to access the complete
record to verify any information about the patient that may need to know, like allergies and
current medications. The health record is easier and quicker to access (AHIMA Work, 2013).
As well as being quicker and easier to use, electronic health records are economical and easier
to read. It also allows patients the access to their information online. Providers can easily
access all of the patient’s medical information at any location (Strauss, 2015).
What are Some Liabilities of Electronic Health Records?
Making sure the accuracy of the health records is maintained, a medical facility needs to be
vigilant that procedure is followed so the information is accurate and not unlawfully accessed
(AHIMA Work, 2013).
Without vigilance discrepancies could occur on the health record. Sometimes “templates” and
“smart phrases” (2013, p. 1) are used when the patient’s information is entered. If these tools
are not used correctly, the validity of the record could be doubted (AHIMA Work, 2013).
If the physician enters incorrect information that will affect the integrity of the record. If
“templates” (2013), are used and they do not address the particular problem, the incorrect
information would be added to the patient’s record. Sometimes “copy/paste” (2013) is used as
a short-cut. It could inadvertently cause inaccurate information to be added to a patient’s
account. “Voice Recognition” (2013) being used without verification could alter the integrity of
the account (AHIMA Work, 2013).
When a patient’s correct information is not verified and guidelines are not followed,
information could be entered on the wrong patient’s account. Complete verification needs to
be made either by a valid ID or other identifying procedures to make sure the correct person’s
record is updated. This would also prevent a duplicate account being set up for the same
patient, when they already have one at that facility (AHIMA Work, 2013).

9. Facilities must make sure that processes are followed to assure the integrity and security of the
“electronic health record” is maintained (AHIMA Work, 2013).
How Important is Teaching Coding to Medical Students?
Tran, Cennimo, Chen & Altschuler (2013) claimthat several audits of outpatient claim records
are reporting error rates as high as 91%. Most medical students are not required to receive
training in correct coding procedures as part of their medical training. The article “Teaching
Billing and Coding to Medical Students: A Pilot Study” (Tran, et al, 2013), felt that it was
important to educate the students about the correct process of “coding and documentation”
(2013). They started a program at Rutgers with this type of training, and hoped to have the
students understand the correct way to document a patient’s account and code it. Physicians
do not enjoy handling the part of healthcare that deals with the coding and documenting
processes. The authors of this article felt that teaching them early when they are still students
would give them a better understanding of the process. They are hoping this understanding
will help in the future with the accurate documentation of patient accounts (Tran, Cennimo,
Chen, & Altschuler, 2013).
How important is the continuous training of medical staff regarding compliance?
The article, “Integrity of the Healthcare Record: Best Practices for EHR Documentation”,
collaborated on by the AHIMA Work Group (2013), argues that medical personnel need to stay
informed on changes regarding billing and coding in order to keep in compliance with state and
federal guidelines. The customer’s account information is considered a legal document and
safeguarding the integrity of the information is important. Ongoing education of staff should be
in place at medical facilities.
For medical coders, ongoing training is very important because there are always new
regulations, new codes, and codes that have been changed. New procedures and laws should
also be included in the training. Meetings with employees between training, with any new
updates, is also important (Prophet, & Hammen, 1998).
Prophet & Hammen (2016) believe that doctors also need to be informed of any problems with
records, because it is important to educate them on improving their documentation on patient
charts. The information the doctor submits needS to be verified so the patient’s account is
coded correctly.
Not only does the “HIM department” need to be educated and informed of all updates
regarding health records, all departments needs to be aware of correct procedures in the
handling of patient information. All training needs to be recorded to meet compliance
standards. The training should always include issues that have been noticed during internal
audits (Prophet, & Hammen, 1998).

10. Conclusions and Recommendations
Conclusions
1. Medical coders play an important part in Healthcare compliance.
2. Internal audits are needed for catching errors and inadequacies in billing processing.
3. Monitoring and auditing claims improves revenue and prevents costly errors.
4. Electronic Health Records benefit medical facilities because of easy access of a patient’s
record.
5. Providers must protect the security of patient information to prevent the information from
unauthorized access of their electronic records.
6. Medical students would benefit from learning coding procedure as part of their training.
7. Education in procedures and compliance of all medical personnel is important.
8. Information on a patient’s account needs to be entered accurately to avoid insurance
companies denying claims.
Recommendations
Guidelines should be put in place to guarantee that patient’s medical records are accurate and
secure. All associates needed to be included in the process. For these reasons the following
recommendations are advised:
Provide full training for all employees particularly medical coders regarding the handling of
medical records.
Assist employees in getting certifications.
When there are changes in policies and regulations all employees should be updated and
explained the changes.
Internal audits should be done twice a year
Personnel should be updated on results of audits by meetings and ongoing training.
Electronic medical records should be guarded against unlawful access. Some suggestions are:
password lock on computers, firewall protection, make sure computers are in secure area,
don’t allow unauthorized personnel into the secured areas, train employees in the proper
procedures for keeping records safe.

11. Doctors should be required to participate in a training seminar on correct medical coding
procedures and how to prevent documentation errors.
These recommendations are very important in preventing non-payment of claims and to
protect personnel information of patients. Employees need to be aware that anything added to
a patient’s chart needs to be verified as accurate and the information safeguarded.

12. References
Stegman, M. S. (2012). CMS Releases Medicare Quarterly Provider Compliance Newsletter —
Guidance to Address Billing Errors. Journal Of Health Care Compliance, 14(1), 63-65.
Ossoff, R. H., Braswell, L., & Raborn, M. (2012). The Value and Role Professional Coders Play In
Health Care Compliance. Journal Of Health Care Compliance, 14(2), 51-52.
Adams, D. L., Norman H., & Burroughs, V. J., (2002).
Allen, B. (2013). internal audits can safeguard hospital revenue. Hfm (Healthcare Financial
Management), 67(9), 106-112.
KUSSEROW, R. P. (2014). Claims Processing Ongoing Monitoring and Auditing: Improves
Revenue and Prevents Costly Errors. Journal Of Health Care Compliance, 16(5), 45-48.
Prophet, Sue. "Coding Compliance: Practical Strategies for Success." Journal of AHIMA69, no.1
(1998): 50-61.
AHIMA Work Group. "Integrity of the Healthcare Record: Best Practices for EHR Documentation
(2013 update)" Journal of AHIMA 84, no.8 (August 2013): 58-62 [extended web version].
Tran, J., Cennimo, D., Chen, S., & Altschuler, E. L. (2013). Teaching Billing and Coding to Medical
Students: A Pilot Study. Medical Education Online, 181-2. doi:10.3402/meo.v18i0.21455
Prophet, Sue. "Coding Compliance: Practical Strategies for Success." Journal of AHIMA69, no.1
(1998): 50-61.
Medical Bill Rehab LLC (2016) 7 Common Medical Billing Errors. Retrieved from
http://www.medicalbillrehab.com/7-common-medical-billing-errors/
3:07 Potential Billing Problems and Returned Claims (2016), MedicalBillingAndCoding.org.
Retrieved from
http://www.medicalbillingandcoding.org/potential-billing-problems-returned-claims/
Fitch, A., (2014,August 11). How to Spot 8 Common Medical Billing Errors. Health, Managing
Medical Bills. Retrieved from

13. https://www.nerdwallet.com/blog/health/common-medical-billing-errors/