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Overcoding and Overbilling: Two Problems with an Easy Solution

Posted by David Fong on Apr 3, 2018 8:00:00 AM

A recent article in Medical Economics pointed out a persistent problem that some physicians continue to overcode and overbill, despite increased focus on the cost of healthcare and scrutiny by federal regulators.  According to the article, a new report by ProPublica, which analyzed CMS data between 2012 to 2015, a number of physicians overcoded on services provided under Medicare’s Part B program.

OvercodingIn the study, ProPublica analyzed provider billing patterns for standard office visits in Medicare and found more than 1,250 providers billed for every office visit using the 99215 code, which is only to be used for visits that involve more intense examination and often consumes more time. Additionally, 1,825 health professionals billed Medicare for the most expensive type of office visits for established patients almost 90 percent of the time in 2015.


In the article, Tom Davis, MD, a primary care physician for more than three decades in St. Louis, Mo., says the problem is severe, driven by employer compensation formula that pay clinicians based on relative value units (RVUs). Clinicians often worry that data-based compensation adjustments are going to decrease their pay and thus may offset by more aggressive coding.


Healthcare consultant David Zetter believes most practices do not know whether they are billing, coding and documenting correctly as most have never had a real billing, coding, clinical documentation review, so they were set up to fail coming out of residency and fellowship.


This is a problem that has a fairly easy solution.


Providers who are not sure whether they are billing, coding and documenting accurately need to take advantage of an outsourced coding and compliance audit service. It will prevent potential coding compliance issues and potentially save money in the long run.


Aviacode provides a comprehensive accuracy review of coding-related practices aimed at maximizing revenue efficiency, identifying potential coding compliance risks, and stopping coding-related denials. Aviacode provides expert and comprehensive accuracy reviews of physicians’ current coding processes, which will identify mistakes and help prevent future coding-related problems and even claim denials. We can help physicians identify their coding challenges before they become a problem.


Our experienced and credentialed auditors are compliant with the latest coding guidelines and changes to ensure that audits are accurate, consistent, and comprehensive. Audits are completed and reports returned typically within three weeks. In addition, we can provide provider and staff education tailored to meet your needs as desired.


Aviacode auditors utilize ProAuditor® software, our proprietary application developed to streamline and standardize audits, and provide audit results that are actionable and easy to understand. ProAuditor, along with our expert auditors, provide a powerful combination to help identify corrective actions, and provide support and training to make them happen. We offer chart audits from physician clinics to multi-site hospital facilities.


Don’t let overcoding become a problem. There is an easy solution.  We look forward in seeing coding compliance executives at the upcoming HCCA Compliance Institute conference at booth #1104.

Topics: Medical Coding, Coding Compliance, Medical Coding Audits, Outsourcing