24 May 2019

7 Medical Coding Mistakes You Must Avoid

The Medical Coding industry was worth more than 12 billion USD in 2018 and is expected to reach double, i.e., over 24 billion by 2025 by achieving a CAGR of over 10 percent from 2019 to 2025. These stats and growth numbers are enough to lure any job seeker into trying medical coding as a profession and having a share of the incredible growth that is bound to happen.

If the lucrative industry has also tempted you and you wish to make a career in it, then you must learn about 7 medical coding mistakes you must avoid becoming a successful coder who delivers perfection all the time.

  1. Upcoding

If patients are billed for services not performed or the procedure performed was simpler than what was done, it is categorized as upcoding. As upcoding leads to an inflated bill, it is wise to avoid it to get more money because it’s illegal and can land you in jail.

  1. Undercoding

Skipping codes or showing less than the procedures done is known as undercoding. It is the opposite of upcoding and is also illegal. Many people do it to avoid audits or reduce the bill of the patient.

  1. Mismatching the Codes

To ensure correct medical coding, it is essential that the diagnostics and treatment codes match flawlessly. If the diagnosis doesn’t prove the need for a medical procedure, the claims can be denied.

  1. Wrongfully Reporting Injection Codes

Some coders report multiple units of code for one session that involved administering of various injections. This is an incorrect approach. Only one code needs to be reported in such cases.

  1. Not Presenting Documentation

When reporting unlisted codes, you must ensure that there is proper documentation because if there is a lack of documentation, it can lead to rejection of claims too.

  1. Being Too Comfortable

You must have heard of the term “know it all.” Some coders think that they know it all within a few years of being on the job. The result, they end up assuming the right codes rather than checking them. This leads to blundering mistakes and wrong coding.

  1. Not Focusing on Demographic Data

The demographic data of patients is essential for every medical coding report. If the data is not there or there is a mistake in data like age, date of birth, address or sex are incorrect, it can also lead to a lot of problems.

The Aim

After reading all these points, you must know that the aim of medical coding should be to ensure that the claims are processed seamlessly and all the people’s whose money is due to get it. The lower the rejections, the higher would be the coding success.

Get the Right Codes Every Time

Now, if you think that medical coding is too tedious, you can outsource it to us, the team of Win Healthcare. We have a skilled team of coders who remember and avoid all the abovementioned mistakes. We also have a quality check system in place that ensures coding errors, if any are eliminated before the delivery to the client. Sounds interesting? Call us for more!


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10 Feb 2018

Types of Medical Underwriting- Moratorium Vs. Full

Have you heard the terms full or moratorium when exploring more about medical underwriting? Ever wondered what they are. We’ll tell you in a jiffy. But first, let us tell you what medical underwriting is. In simple terms, it is a process used by health insurers to decide the price and terms of insurance policies. The process is done by analyzing current and anticipated medical needs of a person.

What is Moratorium Underwriting?

It includes setting a waiting period for pre-existing medical conditions to limit the risk to an insurance provider. This is a good method that helps insurers to keep premiums affordable for members of a plan. A moratorium will not include any pre-existing health conditions for a set period of time, usually two years. After that period ends, it may cover health conditions that come after.

Let’s take an example

If Roger has been suffering from eczema 24 months before his plan started, this disease and any recurring expenses won’t be covered until Roger is free of symptoms and treatment for 24 months after the start day of Roger’s plan.

What is Full Medical Underwriting?

As the name suggests, it involves full disclosure of any and all medical conditions and history by the insurance seeker via a full declaration. The insurance company will then decide whether it can cover those health conditions or not. The underwriting process is somewhat complex and the premiums are high if you have several medical issues or a family history of many health issues and the insurer covers it.

In many cases, the insurer would agree to cover only a few health conditions and, in many cases, the insurer will simply decline to cover any of those. If special terms are applied in your case, it will be visible on your certificate of insurance and the cover will usually be governed by terms and conditions and benefits of your plan.

Moratorium Vs. Full Underwriting: Which One Should You Select?

The choice depends on many factors. Some of them are:

  • Your medical history
  • Your current medical condition
  • Any other medical condition you might be vulnerable to
  • Your personal choice
  • Your finances

We suggest that you talk to an expert or an advisor regarding which option is best for your situation as there is no “one size fits all” solution here. The other option is to contact different insurers yourself and decide what method meets your needs.

Now, if you are interested in hiring top medical underwriters, contact Win Healthcare. We have a team of experts who can create amazing content on the basis of facts and data so that insurance doesn’t cost you too much!

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