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Improve Medical Coding Quality for Proper Reimbursement?

Although the medical coding process is sometimes disregarded, it is an important stage in the healthcare revenue cycle that, if performed incorrectly, can have an effect on every subsequent step. High-quality medical coding is essential to guarantee that claims are handled swiftly and payments are made on schedule.

Due to recent occurrences like the COVID-19 epidemic and the rise in value-based reimbursement, medical coding has grown increasingly vulnerable to revenue loss and decreased income. Since many coders work remotely, there are some issues with medical coding quality, but both in-house and remote providers can still guarantee quality and increase payments.

Your organization’s bottom line will undoubtedly be impacted by inefficient coding techniques, backlogs, and a tight budget, especially if you are also dealing with a small staff and inefficient processes. The performance of the revenue cycle is increasingly impacted by medical coding; as a result, it might be helpful to enhance the work environment for your coders, identify pertinent training subjects, and make the most of the technology at your disposal.

Analyze your coding department in great detail. The following advice will help you increase the effectiveness of your coding operations whether you operate as a one-person show or a multi-specialty team.

1. Coding teams are important

In small practices, providers often handle medical coding independently. Medical coding, however, entails more than just choosing the appropriate codes and invoicing them.

To ensure compliance with payer coding requirements, a medical coder must undertake research, use payer-specific documentation, select appropriate procedure codes, select accurate modifiers based on clinical circumstances, appeal denials with the required data, and perform coding audits.

Due to their busy schedules, inpatient care providers don’t have enough time to keep up with payer-specific rules and coding updates. So it’s preferable to outsource your medical coding services to get 100% accuracy for your insurance claims.

2. Take Advantage of Advanced Technologies

The adoption of Electronic Health Records (HER) has transformed medical coding. The paper-intensive process’ transition to the digital era has a significant impact on the EHR software. To increase the caliber and accuracy of medical coding, a number of different technologies can be used in addition to the EHR system.

You can improve the quality and accuracy of medical coding with Computer Assisted Coding (CAC) systems. To establish the appropriate medical codes for a particular document, it examines medical records. Using computer-aided coding tools eliminates the need to comb through coding books. In order to improve accuracy, your coder will receive automatically proposed codes whenever CCI and LCD updates take place.

3. Performing audits of the coding quality

Are you satisfied that coding audits are carried out frequently whether you work for a small clinic, a big hospital, or a group of doctors? The time and money your office, clinic, or hospital may save by conducting monthly code audits is enormous. There are several types of coding audits, and your company might need to do any or all of them.

It could be a RAC audit support, a DRG verification, or an assessment and management coding audit. Each of these in an organization has a unique value and function to play in handling health information. You might be wondering why you should spend money on expert coding audits when everything appears to be going well already. You might need to assess whether your business is operating as effectively as possible.

Narrowly focused practices may necessitate more regular audits than others due to the complexity of the medical coding involved. Additionally, it may be a good idea to perform coding audits more frequently if your clinic has recently hired new medical coders or if those coders work in a field they are unfamiliar with. It is hoped that doing this will lessen the likelihood of errors occurring under these conditions.

Providers and internal coders can learn from their mistakes as a consequence of coding audits, which will enhance results and result in fewer mistakes moving forward. Your medical coding staff will be of much higher caliber if you do regular audits of your code. Choose the medical billing audit to reduce the denials and efficient auditing services.

4. Transparency in Communication

The provider and coding team must regularly communicate to ensure that all procedures are properly documented, that coding is done appropriately, and that no treatments are missed because they are not billable. Coders should be advised of audit findings and modifications to coding standards as soon as practicable. As a result, developers can rapidly enhance coding quality by modifying workflows. When there are so many coding updates issued, especially when so many changes affect coding, coders benefit from communication as well.

Every year, many codes are added, a few are removed, and others are revised. We saw numerous coding modifications. Changes to telehealth rules, the addition of several new codes for COVID-19 immunization and administration, and changes to all payer code sets are also part of the package. Coders and providers should collaborate proactively to standardize coding practices when such updates occur.

5. Stay up to date on healthcare changes

Annual updates to the CPT, HCPCS, and ICD-10 are made. Your coders should be aware of and comprehend all recent changes in coding, but it is critical that they understand the impact of value-based care and new reporting requirements on patient care costs now more than ever.

Among the numerous risk adjustment models available, Hierarchical Condition Categories (HCC) has been around for a long time but has grown in popularity when Medicare Advantage Plans began requiring risk adjustment factor (RAF) scores. Every code leader and commercial payer should be aware of it as of today. HCC cannot be comprehended without a fundamental understanding of Risk Adjustment (RA), and vice versa.

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