Medical coding is an important part of the claim cycle and is required for claim reimbursement. Incorrect coding can harm your practice in various ways, including lost revenue, potential overpayments, and assertions of abusing reimbursement guidelines. Medical coding has an important impact on revenue cycle performance, so analyzing your coding department is necessary. It can assist you in locating lost dollars due to discharges that were not fully billed or reduce coding-related denials.
Medical coding analytics by facility or provider can assist you in identifying critical clinical documentation issues that can assist you in improving coding quality.
Inefficient coding practices, long delays, and a modest budget will impact your organization’s bottom line, especially if you’re dealing with inadequacies, backlogs, and a small staff. Because the impact of medical coding on revenue cycle performance is increasing, enhancing your coders’ work environment, determining suitable topics for training, and maximizing available technology can all be beneficial.
Examine HCCs And SDOH
The Centre for Medicare and Medicaid Services (CMS) has approved the use of Hierarchical Condition Categories (HCC) coding to determine Medicare reimbursement. HCC codes use information about a patient, such as age, identity, and overall health status, to determine risk adjustment factors in determining the patient’s estimated healthcare expenses. HCC method enables providers to be adequately paid for treating high-risk patients while still providing quality care.
Physicians must record and report the patient’s condition using the MEAT (Monitoring, Evaluating, Assessing, and Treatment) standards, making coders assign the relevant codes.
Social Determinants of Health (SDOH)
Accurate Coding for Social Determinants of Health (SDOH) improves the quality of care and experience while lowering readmissions and contributing to a healthy revenue cycle. SDOH can be classified into five groups: economic circumstances, (ii) educational level and quality of education, (iii) access to quality healthcare, (iv) neighborhood in which they live, and (v) social structure and community context. To check the SDOH, medical coders must use “Z” codes. The “Z” codes can assist a coder in identifying personal medical history, family medical history, and other relevant information.
Establish A Coding Team
Most providers handle medical coding on their own in small practices. However, medical coding is more than just selecting the correct procedure codes and billing them. Medical coding entails payer-specific paperwork, selecting appropriate procedural codes, selecting appropriate modifiers based on clinical scenarios, appealing denials with the necessary information, and conducting coding audits to ensure compliance with payer coding standards. Because providers are busy with inpatient care, they don’t have time to catch up with coding notifications and payer-specific rules. As a result, it is preferable to outsource medical coding to professionals.
Conducting Quality Audits
Performing coding quality audits regularly is essential to improving medical coding quality. According to a Change Healthcare study report, over $262 billion in claims are initially denied each year, primarily due to a lack of patient data. The same study discovered that a lack of clinical documentation was directly responsible for $28 billion in declined funds. Internal monthly coding audits will help avoid ‘soft’ denials that require extra information for reimbursement. Quality audits will guarantee that all coders adhere to payer-specific coding standards.
Regular coding audits can identify the areas where revenue is lost due to bad routines, workflow concerns, or inadequate training. Coding audits will reveal inconsistencies between your practice’s billing information and average income. This gap could result from potential fraud or non-compliant coding and billing practices. Coding audits will also provide your practice with an impartial assessment of your medical coding quality. Coding audits must be performed regularly, and data stored in proper format for comparison.
Utilize Advanced Technologies
The use of Electronic Health Records has revolutionized medical coding. Bringing the paper-intensive procedure into the digital era resulted in a significant change in EHR software. Aside from the EHR system, several other innovations can be used to enhance the quality and accuracy of medical coding.
You can enhance the precision and quality of medical coding by implementing Computer-Assisted Coding (CAC) solutions. It analyses healthcare files to evaluate which medical codes are appropriate for a given file. When using computer-assisted coding software, it is no longer required to search through coding books.
Keep Up To Date On Healthcare Developments
CPT, HCPCS, and ICD-10 codes are updated every year. Coders should be capable of understanding all recent changes in coding. Still, now more than ever, it is critical that they realize the effects of value-based care and new reporting standards on patient healthcare expenses.
The suggestions mentioned above will give a better idea for optimizing your coding department and ensure that you’re ready for today’s challenges and future developments in the healthcare industry while enhancing your revenue cycle performance. It is critical to develop and integrate a strategy that works best for your team to avoid the negative consequences of incorrect coding.
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