Medical Coding

Medical Coding Significant Impact on Revenue Cycle Management

Medical Coding is an important aspect of a medical practice’s revenue cycle. If appropriate codes are not utilized or erroneous information is entered, claims are frequently denied by insurance companies. For expected payments and efficient operations, accuracy when coding and billing medical claims is crucial. Let’s take a look at some key components of medical billing that will help you increase your revenue cycle management.

1) Pay attention to HCCs and SDOH:

Reports indicate that growth in value-based buying and at-risk payment models has sparked interest in improving the health of the populations managed. As a result, precise risk factor labeling is required. The importance of HCC coding and SDOH capture has risen to new heights. Providing high-quality treatment while lowering costs and avoiding revenue loss for healthcare providers will necessitate a complete deep dive that will leave no stone unturned.

To calculate Medicare reimbursement, the Centers for Medicare and Medicaid Services (CMS) requires the use of Hierarchical Condition Categories (HCC) coding. HCC codes generate a risk adjustment factor based on a patient’s demographic variables, such as gender, age, and current health condition, to predict the patient’s anticipated healthcare cost for the year.

While providing value-based care, HCC coding helps physicians to earn appropriate and fair reimbursement for treating patients with higher risk. As a result, managers and leaders must make certain that all stakeholders are aware of the importance of accurate HCC coding in revenue cycle management.

Similarly, social determinants of health (SDOH) coding enhances patient care and experience while also lowering readmissions and contributing to a healthy revenue cycle. SDOH refers to the socioeconomic factors in the patient’s environment, which are divided into five categories:

(i) Stability in economy

(ii) Access & quality in education

(iii) Healthcare access & quality

(iv) Neighborhood & environment,

(v) Social & community.

According to SDOH standards, all doctors, including physicians, case managers, social workers, nurses, and others, must gather data on social needs such as food, homeless, and social isolation by 2021. Coding managers must ensure that coders are familiar with SDOH Z code use cases and that they are given the assistance and motivation they need to complete coding for social needs, which was originally provided lower priority.

2)Tips to improve Medical Coding quality:

Ultimate Use Technology

Medical Coding was transformed by electronic health records, which brought the paper-intensive procedure into the digital era. While the EHR system remains essential to the medical coding process, new technologies have emerged to increase the quality and accuracy of medical coding.

Computer-assisted coding (CAC) systems, for example, are software packages that can evaluate healthcare records to determine the relevant medical codes for clinical documentation. According to AHIMA research, the solutions speed up the medical coding process while simultaneously enhancing coding accuracy and efficiency.

Conducting Coding Quality Audits

Even though coding technology has simplified medical coding, coding quality audits remain an important part of a comprehensive medical coding improvement approach.

These “soft” denials, which need more information for reimbursement, should be avoided by ensuring medical coding processes are up to the payer code. Internal audits of these procedures might reveal locations or kinds of situations where money is being lost due to bad practices, workflow inefficiencies, or even inadequate training. Any discrepancies between an organization’s billed statistics and the national average should be investigated. Variations identified may or may not suggest potential fraudulent or abusive billing and coding practices. While health IT firms can conduct audits for businesses to acquire a fresh perspective, providers should still undertake internal audits regularly to discover coding errors that affect medical coding quality.

Make Use of Professional Coders

To adapt to the changing demands of health care, coding standards and regulations change frequently. Medical coders spend years honing their skills through experience and certification, which is why working with coding professionals is a great strategy to increase coding accuracy and increase revenue. Coders can assist in filling documentation gaps and offer providers useful feedback and training.

Consider the following before choosing or partnering with a medical coding firm:

1) Staffing resources that fit your requirements

2) Certifications – specialty-specific certifications.

3) Hands-on experience in years.

4) A proven track record of successful case studies or testimonials from customers & employers.

Improve Your Documentation Skills

One of the quickest ways to improve medical coding accuracy is to improve documentation. The greater the compensation, the more information a provider adds to his or her documentation. It’s important to remember that reimbursement is based on what’s in the patient’s medical record while documenting your appointment with them. If your practice is experiencing difficulties with documentation, speaking with a Clinical Documentation Improvement (CDI) Specialist might be helpful. The CDI Specialist can go over your process and walk you through the correct documentation to assist you to optimize coding and getting the best reimbursement.

3) What can MBW (Medical Billing Wholesalers) do for you?

To offer outstanding revenue cycle outcomes to their clients, their comprehensive delivery strategy blends their people’s knowledge with market-leading technology. MBW assists clients in the following ways:

  • Lowering processing and collection expenses
  • Cut costs in areas like buildings and technological infrastructure.
  • Increase process efficiency (coding and billing accuracy, claim acceptance rates, days in accounts receivable, collections total values and revenue losses)
  • Boost compliance and reduce audit risk

The workflow systems from MBW assist clients in coordinating processes and seamlessly implementing process coordination. With a thorough understanding of volumes and process-specific subtleties, MBW can establish an automation strategy and develop long-term technology solutions.

4) Benefits of Medical Coding and Medical Billing:

Successful medical billing and code administration is proven to be a strategic advantage for healthcare practitioners in today’s complicated and growing healthcare economy. It’s no surprise that doctors, healthcare organizations, hospitals, and practice managers have turned to bill and coding outsourcing as a way to boost profits.

Let’s have a look at the benefits:

Billing Errors are reduced

Medical billers, who have undergone considerable training and experience, are well-versed in the complexities of claim submission. They not only lower the number of claims that are denied, but they also check and modify claims for errors before forwarding them to the payer.

Improves Cash Flow

Medical billing outsourcing services help companies to maintain a regular cash flow and faster collection regardless of their staffing situation. Allowing a specialist agency to handle medical billing swiftly allows hospitals to gain higher economies of scale.

It is cost-effective.

One of the key motivations for outsourcing has always been to save money. Hospitals can save expenses on wages, training, and benefits by outsourcing medical billing. Hospitals can also save money on office supplies, furniture, and hardware purchases or improvements.

Final Thoughts

The process of Medical Coding has a profound influence on revenue cycle performance in the new era of value-based reimbursements. Medical coding is tucked away in the center of the revenue cycle, passively doing its job. Charges go out the door faster when done correctly and properly, and the claim is evaluated effectively in the quickest period feasible. Choosing the right medical billing partner, such as Infognana, can help you manage your revenue cycle more effectively.