How can I reduce coding errors in my practice?

Regular medical coding training, detailed documentation, and the use of advanced coding tools can significantly improve coding accuracy. Conducting routine coding audits helps identify patterns and prevent repeat mistakes. It’s equally important to maintain open communication between coders and healthcare providers to ensure consistent documentation and compliance with medical coding best practices.

What should I do if a claim is denied due to coding issues?

Start by reviewing the denial reason and verifying that your documentation supports the ICD-10 and CPT codes used. Work with your coding team to identify any gaps or inaccuracies and correct them before resubmitting the claim. Following medical coding compliance guidelines and maintaining accurate documentation will help reduce future denials and strengthen your overall revenue cycle management.

How can technology improve medical coding accuracy?

Modern coding software and AI-driven medical coding tools can automate repetitive tasks, flag documentation errors, and recommend the correct codes in real time. Integration with Electronic Health Records (EHRs) enhances workflow efficiency, reduces manual entry errors, and ensures consistent medical coding accuracy and speed. These tools help coders focus more on analysis and quality assurance instead of data entry.

Are certifications important for medical coders?

Yes, certifications such as CPC (Certified Professional Coder) and CCS (Certified Coding Specialist) are essential for maintaining medical coding accuracy and compliance. They validate a coder’s expertise in ICD-10 and CPT coding systems, ensuring they stay up to date with the latest medical coding best practices, payer regulations, and documentation standards. Certified coders are more likely to deliver accurate results, reduce denials, and improve reimbursement outcomes.

How can I reduce coding errors in my practice?

Regular medical coding training, detailed documentation, and the use of advanced coding tools can significantly improve coding accuracy. Conducting routine coding audits helps identify patterns and prevent repeat mistakes. It’s equally important to maintain open communication between coders and healthcare providers to ensure consistent documentation and compliance with medical coding best practices.

What should I do if a claim is denied due to coding issues?

Start by reviewing the denial reason and verifying that your documentation supports the ICD-10 and CPT codes used. Work with your coding team to identify any gaps or inaccuracies and correct them before resubmitting the claim. Following medical coding compliance guidelines and maintaining accurate documentation will help reduce future denials and strengthen your overall revenue cycle management.

How can technology improve medical coding accuracy?

Modern coding software and AI-driven medical coding tools can automate repetitive tasks, flag documentation errors, and recommend the correct codes in real time. Integration with Electronic Health Records (EHRs) enhances workflow efficiency, reduces manual entry errors, and ensures consistent medical coding accuracy and speed. These tools help coders focus more on analysis and quality assurance instead of data entry.

Are certifications important for medical coders?

Yes, certifications such as CPC (Certified Professional Coder) and CCS (Certified Coding Specialist) are essential for maintaining medical coding accuracy and compliance. They validate a coder’s expertise in ICD-10 and CPT coding systems, ensuring they stay up to date with the latest medical coding best practices, payer regulations, and documentation standards. Certified coders are more likely to deliver accurate results, reduce denials, and improve reimbursement outcomes.

Behavioral Health Billing Case Study

A behavioral health clinic in North Las Vegas providing Applied Behavior Analysis (ABA) services was facing a confusing and familiar challenge. Their billing team was overwhelmed. Their claims were getting denied, payments were delayed, and manual follow-ups were taking important and valuable time that could have been spent serving patients. The owners knew they needed expert help to bring order, structure, visibility, and consistency back into their revenue and manage this whole cycle. That’s when they reached out to Pro-MBS. Within six weeks, their clean claim rate jumped to 97%, denials fell to 11.05%, average payment turnaround dropped from 55 days to just 25, and monthly revenue grew by 36%.

Here is how we made that happen.

About the Client

The client is a small ABA therapy practice based in North Las Vegas, Nevada, serving around 20-25 families every month. Their sole mission is to provide behavioral therapy that helps children achieve meaningful and developmental milestones. They used Central Reach (CR) for billing and Office Ally as their clearinghouse. With only a few staff members handling multiple payers and complex rules, billing accuracy often took a back seat and malfunctioning began to happen. The result was the only constant struggle to keep revenue stable and operations compliant.

Challenges Faced by the Practice

Before we stepped in, the practice’s behavioral health billing system was more reactive than proactive. The team spent most of their time fixing problems after denials came back instead of preventing them from happening in the first place.

Here’s what we uncovered during our initial assessment:

Low clean claim rate (85.01%) and high denial rate (20.52%), creating long payment delays, sometimes up to 55 days.
Authorization gaps, with some requests missing or expired before sessions took place.
Incorrect or missing modifiers such as UD, HM, HO, and 76, causing automatic rejections.
CPT/ICD-10 mismatches that triggered medical necessity denials.
Missed payer deadlines due to manual claim tracking.
Outdated insurance data and missing treatment plans that slowed approvals.
No denial tracking system, so recurring issues went unnoticed.
Manual follow-ups and payment posting consuming staff time.
Denied claims not being reworked promptly, leading to unnecessary write-offs.

The team was doing its best, but without proper analytics or automation, there was no clear picture of where money was being lost.

How Pro-MBS Addressed the Challenges

We came in with one clear goal: to rebuild thei billing workflow into something lean, accurate, and fully compliant. Our strategy was structured but flexible enough to adapt to the practice’s real-world challenges.

We followed a five-step improvement plan, each designed to deliver visible results within weeks rather than months.

1. Comprehensive Workflow and Compliance Audit

Our engagement began with a three-day audit of the practice’s billing and documentation process. We reviewed claims, authorizations, and coding accuracy across all payers. Our certified professional coders (CPCs) performed a detailed modifier and CPT/ICD-10 audit to correct inconsistencies and align every billed service with CMS and payer-specific rules. The insights from this audit became the blueprint for the next steps.

2. Strengthening Front-End Accuracy

We tackled errors at the source before claims were even created.

By introducing real-time eligibility and benefits verification, every patient’s coverage was confirmed before the visit. We also set up a centralized authorization tracker with automatic alerts for expiring or pending approvals. This alone prevented dozens of denials that previously came from authorization lapses or outdated coverage.

3. Pre-Billing Validation and Denial Prevention

Our team also implemented a pre-billing validation layer that automatically checked for missing demographics, wrong modifiers, or invalid CPT codes. We also built a denial management framework that categorized denials by its main and root cause such as authorization, coding, eligibility, or timely filing. To make their recovery faster, we created many customized appeal templates and trained staff to use them for consistent follow-ups.

4. AR Optimization and Payment Automation

We automated accounts receivable (AR) segmentation by payer and age bucket (0–30, 31–60, 61–90, 90+ days). This made it easy for them to prioritize high-value or older claims first. To reduce human error, the practice was moved to ERA/EFT enrollment, eliminating manual payment posting and making reconciliation automatic, faster, and more accurate.

5. Performance Monitoring and Staff Empowerment

We built a dashboard for them that showed key performance indicators in real time such as claim volumes, denial rates, and AR aging trends. For the staff, we ran short training sessions on eligibility verification, modifier use, coding accuracy, and appeals documentation. These sessions not only helped the internal team understand not just what to do, but also got the whole team compliant. But why each step mattered for compliance and cash flow.

The Results

In just six weeks, the practice began to see measurable amount of improvements across every metric that mattered the most.

KPI	Before	After (6 Weeks)
Clean Claim Rate	85.01%	97%
Denial Rate	20.52%	11.05%
Avg. Reimbursement Time	55 Days	25 Days
Staff Hours Saved	—	30 Hours/Month
Revenue Growth	—	+36%

Their billing team now operates with confidence, backed by clear data and automated systems. Claims go out clean, payments come in faster, and the clinic finally has the Soothing breath room to focus on what they do best and that is patient care.

Looking Ahead

The improvements we brought for them were not short-term. By integrating automation, training, and consistent reporting, the practice built a foundation for long-term stability. Today, their billing operations run with super clarity, accountability, and measurable control. Instead of chasing denials, the team now focuses only on maintaining compliance and growing their practice.

Visit our website to schedule your free RCM audit and discover how Pro-MBS can help you reduce denials, improve compliance, and accelerate cash flow.

Ready to strengthen your revenue cycle? Schedule your free RCM audit with Pro-MBS and discover how a structured, data-driven billing process can reduce denials, improve compliance, and accelerate your revenue growth.

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Behavioral Health Billing Case Study | Pro-MBS Results