What are potential consequences of inaccurate CPT coding?

Inaccurate CPT coding can lead to a variety of significant consequences that can severely impact both the healthcare provider and the patient. Claims denials occur when insurance companies cannot validate the services billed due to incorrect coding, leading to delayed payments that affect the financial stability of healthcare practices. Additionally, persistent inaccuracies in coding can trigger audits, resulting in potential legal issues, such as accusations of fraud or improper billing practices.

Consequences like these not only strain the relationship between healthcare providers and insurance companies, but they also disrupt patient care, as financial resources may be tied up in disputes rather than being directed towards patient services. Therefore, ensuring the accuracy of CPT coding is crucial for timely reimbursements, compliance with regulations, and the overall effectiveness of healthcare delivery.