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Looking Beyond Revenue Loss: The Repercussions of Improper Coding

Looking Beyond Revenue Loss - Exdion Health


Understanding the Importance of Medical Coding


Precise medical coding is crucial to receiving reimbursement from your insurance company. It also helps with maintaining proper documentation and records of the patients. When the code is inaccurate, the insurance company can deny claims that would otherwise be approved.  


Insurance claims are denied typically due to two common improper coding types: 


Under-coding: This affects provider reimbursement and results in you being underpaid for the services you provide to clients. When you under code, you eventually end up losing money. 


Over-coding: This practice involves providers getting far higher reimbursements than they should. The penalty of getting caught far outweighs getting a higher paycheck for your services. When you exercise incorrect coding, your patients and the company will encounter adversity. Miscoding is known to harm the overall revenue generated by a company. At the same time, it also directly impacts the documentation of the patients. 


For instance, a patient undergoing treatment for a knee injury needs to be referred to a specialist. Entering the appropriate code becomes essential to ensure that the specialist can treat the patient. Even a minor error in code might provide incorrect patient information, leading to improper healthcare. These mistakes are common in the healthcare sector. However, such mistakes can adversely affect the overall patient experience and the entire practice.


How can Improper Coding Harm Your Medical Practice?


Failure to offer the right codes can eventually harm the entire practice. Some typical consequences are: 


Denial or Delay of Reimbursement: Both over and under-coding can result in too little or too much reimbursement. When coding is not correct, the chances are that your practice will not be reimbursed for the right amount. This can cause a blow to your overall operations It will eventually lead to a loss of time and revenue due to miscoding. 


Insurance Carrier Audits: If your insurance carrier senses abuse or fraud, they have the authority to audit your practice. The auditing process will ensure an in-depth analysis of the entire coding procedure. It could also determine whether your practice is in debt.   


Charges of Abuse or Fraud: Your practice will be penalized if your insurance provider detects any abuse or fraud due to over-coding. However, these are easy to avoid with correct coding practices. It takes time to work through these fines.   


Lengthy Processing: Claims submission is a time-consuming process. However, once you identify errors in claims, you can think of correcting and resubmitting the claim. As a result, your practice will lose time that you might not be able to afford. All these delays ultimately prolong the reimbursement process.


Improving Medical Coding with AI and NLP 



The consequences of reputational and financial damage due to incorrect coding practices are highly damaging. They often take a lot of time and effort to recover. With modern technologies, healthcare centers constantly seek to improve organizational processes and minimize revenue losses due to common coding errors. 


This is where AI-powered CAC or Computer-aided Coding software solutions come into play. These revolutionary systems use NLP’s linguistic capabilities to obtain clinical indicators from unstructured data – including prescriptions and notes. This information can be used towards allocating the right clinical codes. In addition, voice-enabled NLP can be instrumental in obtaining information from dictation for the overall ease of identification as well as translation to the appropriate coding format. 


Clinical NLP and AI-enabled CAC aids the streamlining of the clinical coding process while allowing organizations to minimize denials. It will also ensure top-notch quality control. The overall speed with which the tools operate will boost the productivity of the entire coding team. This allows hospitals to effectively eliminate inaccuracies in the respective codes. The CAC tool also detects the probability and pattern of claim denials. This will guide the billing team to concentrate on specific areas to enhance payment returns. 


AI-enabled CAC software solutions are known to have the potential to streamline the coding programs of the healthcare centers while adding value to the respective revenue streams. This will allow them to ensure a robust coding framework while introducing innovations to help them serve as pioneers in the transformation of the healthcare industry.




For healthcare centers, offerings such as a complete suite of CAC or Computer-Aided Coding solutions that use clinical NLP (Natural Language Processing) will offer relief against the struggles of inaccurate coding. A comprehensive service platform which helps healthcare centers gain meaningful insights from unstructured data is the key. It can then organize the available data into a structured format for conducting clinical analysis.  


This reliable Software as a Service (SaaS) solution can help reduce time, error margins, cost, and the effort to invest in clinical coding and processing. Exdion’s revenue cycle management (RCM) solutions bring a mix of cutting-edge technology and top-class strategy to provide you with the best-in-class solutions including but not limited to: 


  • Standardized systems, processes, and practices across the board 
  • Absolute AI takeover of manual processes 
  • Superior payment experience for all patients 


Find out how Exdion Health best-in-class coding automation solutions can help enhance your revenue integrity. Get in touch with us today!

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