What’s keeping medical coders up at night?

By Andrew Cass for Becker’s Hospital CFO Report

Regulatory challenges, evolving coding practices and ethical concerns are the critical issues facing medical coders, according to an Oct. 18 report from Black Book Research. 

Here are five things to know from Black Book’s survey of health information management professionals: 

1. Ninety percent of those surveyed said that upcoding is a major ethical dilemma for staff coders. An employee who is ordered to perform illegal coding might be considered an involuntary accomplice if they are coerced, if they are set up to take the blame for illegal activities, according to the report. Eighteen percent of respondents reported facing pressure from their employer to engage in what they described as fraudulent coding for provider financial gain. 

2. Eighty percent of respondents said they were anxious over the required training and potential for increased coding errors as the industry prepares to transition to the more complex ICD-11 system. 

3. Eighty-five percent of respondents said that discrepancies identified during coding audits — often leading to denied claims or repayment demands — result from the complexity of the current system. 

4. More than half of those surveyed said they believe building services into a single code underestimates the true scope of care provided, but unbundling risks billing fraud accusations. 

5. Artificial intelligence and machine learning are being used to automate processes, but 94% of those surveyed said they are concerned about the accuracy and nuance of AI-generated codes and 97% believe critical human oversight may be lost. Additionally, 77% said they are concerned about AI’s potential to perpetuate biases in billing and access.