Medical coding is critical for ensuring potential claims are filed properly and for proper revenue collection. Coding affects the performance of a practice’s revenue cycle management which decides the accuracy of all claims that are submitted to different insurance providers including Medicare. It is therefore important that healthcare practices analyze their coding practices and find ways of improving them.
Leveraging Available Tools and Technologies
The digital era has introduced healthcare coders to solutions that paper-based systems did not have. The uptick in the use of Electronic Health Records (EHR) has eased revenue processing in healthcare settings.
Additionally, leveraging available technology for coding processing, ratification of coding issues and approval has led to accelerating growth of healthcare practices. These advantages mean that practices should use EHR which integrates coding and the EHR chosen should allow medical professionals and coders to choose the right codes for a given patient in line with the available documentation.
The use of computer-assisted coding systems has also helped healthcare organizations make their coding more efficient. They do this by identifying gaps in documentation and providing suggestions for improving coder productivity and accuracy.
Once these systems are online, the streamlined coding solutions they provide can be used elsewhere. For example, diagnosis codes produced by these systems are used in Medicare Risk Adjustment (MRA) calculations. These calculations allow healthcare practices to calculate the financial impact of diagnosis recapture. By using an MRA calculator and entering the right codes and other patient information, healthcare practices can better understand the changes they can expect in their risk pool funding.
Hiring the Right People
Medical coding is a tedious and complicated process that requires the knowledge and skill of experienced and talented coders. In addition to that, we have the implementation of consistent standard coding that requires additional talent. Lastly, we have the evaluation of existing coding practices to find areas of improvement, which also requires dedicated coders.
It is, therefore, critical that revenue cycle leaders and healthcare practices choose coders who can oversee the training of new coders but who can also change directions if so required. They must also adhere to the coding standards set and used by the practice while also making necessary transitions when required.
Conducting Regular Compliance Audits
Accurate coding is critical for the profitability of any healthcare practice. Standardized codes allow coders to easily translate clinical documentation that they can then turn into billing documentation. Coders must therefore support any quality compliance audits that the healthcare practice decides to conduct.
The compliance audit evaluates a small sample of charts for different medical coders to see if the information they recorded is accurate. This is the best way to ensure clinical documentation is of a high-enough quality.
It is common for healthcare practices to outsource this process, especially in cases where they do not have medical coders experienced enough to conduct such extensive and thorough audits.
Taking a deeper look at your coding team’s systems, methods and structures is a great place to start when improving medical coding. It is also important to give them the tools they need to not only ensure compliant coding but to allow their coding to support other parts of the business such as risk assessment.
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