It is essential to take the time to examine your coding department because the efficiency of the revenue cycle is greatly affected by medical coding service. You can utilize it to uncover lost money because of incomplete discharge bills or to lower denials because of coding issues. You may improve coding quality by identifying important clinical documentation errors with the use of medical coding analytics that a facility or clinic offers.
Your sales cycle is a continuous process. You can fix the coding-related issues that you find during the initial analysis and corrections at a high level. To ensure that the issues found are not reoccurring, you must continuously examine your coding quality and make structural improvements.
We hope that the tips we provide below will have a beneficial impact on your revenue cycle performance because they are based on our expertise in developing high-quality coding programs, especially for a US medical billing company.
-
Don’t Ignore HCCs and SDOH
Risk factor valid coding More than ever, HCC coding and SDOH (Social Determinants of Healthcare) capture are essential.
HCC Coding
The Centre for Medicare and Medicaid Services (CMS) approvedHierarchical Condition Categories (HCC) coding used to determine Medicare reimbursement.
HCC codes analyze a patient’s data, including age, gender, and current health state, to derive risk adjustment variables that establish the patient’s anticipated annual healthcare costs. By using HCC coding, healthcare professionals may deliver value-based care compensation for treating patients at higher risk.
Using the MEAT (Monitoring, Evaluating, Assessing, and Treatment) criteria, doctors must record the patient’s status with the utmost accuracy. This makes it simpler for coders to assign the appropriate codes.
Social Determinants of Health
The same is true for accurate coding for social determinants of health (SDOH). It enhances patient care and satisfaction while lowering readmission rates and supporting a robust revenue cycle. The following five categories of SDOH come under examination: I economic circumstances; (ii) educational background and quality; (iii) access to high-quality healthcare; (iv) neighbourhood; and (v) social strata and community milieu.
Medical coders must mark the SDOH with “Z” codes. The “Z” codes help to identify things like drug usage, personal medical history, family medical history, and diseases. The coders with ICD-10-CM must become familiar with documented SDOH and code them.
The current practice of ignoring “Z” Codes is essential to the success of the Medica Coding function but will not last in the long run.
-
Focus on EMR workflows while learning from Claim Denial Reports
It takes time to work on claim denials because they require revision, research, and resubmission. By looking over your claim denial records, you can identify coding errors and can assume that they have regular make.
Editing your coding workflow by configuring systemic checks
Recognize how your revenue cycle system operates and, if at all possible, develop systemic validations to assist you to spot recurring mistakes. You may stop these errors and quicken cash flow by using system-driven validations.
Remedial Training
Review coding denials with your coding team on a regular basis, ideally every two weeks. Determine the cause of the top 5–10 coding-related denials by looking at them. Frequently, it can be a result of incorrect clinical recording in the setting or a lack of knowledge of the proper codes for a specific technique. A brainstorming session will help you solve many of the coding problems you’re currently having by educating the coders on the proper codes.
Coding Team’s Workload
The business is suffering from a chronic scarcity of skilled medical coders. The Medical Coding team has unreasonably high production expectations as a result of the shortage of qualified resources. Burnout among coders is a problem that many organizations ignore. You may balance the workload of the coding team, establish reasonable productivity objectives, and enhance morale and coding quality by right-sizing the team.
-
Conduct Coding compliance audits – Annually, At Least
Coders assist healthcare facilities’ quality compliance processes by interpreting documentation using standard codes and coding criteria.
Coding compliance audits can improve revenue cycle operations, lower the frequency of claim disputes and denials, and guarantee compliance with local and national healthcare laws. A high-performing revenue cycle base on precise coding.
Making sure medical coding techniques adhere to the stated policies and norms can result in a lot of denials that demand further information before being reimbursed.
For each certified medical coder, a coding compliance audit assesses a statistically valid sample of charts to examine the codes entered and the calibre of clinical documentation. In order to obtain the knowledge they lack internally, many facilities are turning to outside parties for ongoing Coding Quality Audits and annual coding compliance audits.
-
Outsource Coding to a team of certified medical coders
Today, it is common practice to outsource medical coding operations, including ongoing coding and quality assurance procedures. It can be challenging to find qualified and experienced coders given the current revenue cycle labor shortage. So, It may be extremely harder to locate coding talent with a particular specialty.
Additionally, outsourcing your code can assist you to speed up innovation in the sales cycle because the partner you engage with might make numerous enhancements to your coding workflow to raise the caliber of the final product. The playbooks they have available for various specialties and revenue cycle systems can raise the standard of coding as a whole.
Final Thoughts
The impact of poor-quality coding is visible very fast in your revenue cycle metrics, whether you are dealing with a high rate of coding denials, not achieving best-in-class A/R outcomes, or having trouble recruiting the right team of trained coders.
Many of the problems causing a large number of coding denials can be resolved by a team of professional coders. Correct reimbursements depend on correct medical coding. Claims denials, unnecessary compliance problems, and financial ruin can all be brought on by medical coding errors.
Finally, Your coding team’s structure, procedures, and systems need to be thoroughly reviewed in order to address code quality issues. A high-quality coding team can develop a sustainable approach to providing high-quality coding services, and code audits can help you uncover the problems.
