 Medical care providers are offering the best cutting-edge care for their patients. Howbeit, for successfully endowing the medical practices requires medical billing. In today’s ergonomic medical industry, business issues are rising that are concerned with the medical billing & coding.

 Upcoding: This happens when billing codes are changed to symbolize more severe treatment or diagnosis. This causes medical bills to inflate. Upcoding happens when patient treatments are coded for a name-brand medication or a regular visit to the doctor is coded as inpatient care.  Unbundling: It occurs when medical charges that can be bundled jointly are listed separately. This makes the medical bill to increase as every treatment is billed separately. Examples are when medical tests should be treated under same code are billed individually.

 Balance billing: It occurs for the leftover ‘balance’ after insurance companies settled the medical bills with the hospital or care provider. Care should be taken whether all the hospital charges are covered under the policy or not.  Duplicate billing: It occurs due to services or procedures billed multiple times. The most common example is when doctors & associate staff bills for the same service or procedure for a couple of times.

 Lack of medical requirements: If the hospital or care provider is not able to offer coder with information about the diagnosis, then wrong codes may lead to higher medical bills.  Differing treatment codes: If medical coder upcodes the diagnosis and leaving treatment codes, the insurance company will reject the claim due to mismatch between treatment & diagnosis codes. Especial care should be taken while coding for both diagnoses & treatments.

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