Introduction
The revenue cycle’s purpose is to get paid. So, how can you ensure you get compensated correctly and on time? The solution may appear complicated, yet ultimately it boils down to a precise code.
Medical billing and coding are two of the most critical aspects of the revenue cycle. Yet, the necessity of appropriate coding is not always monitored, analyzed, or facilitated as much as it should be. Accurate medical coding results in clean claims, timely reimbursements, and a healthy bottom line. Coding mistakes in the medical billing process might result in revenue losses.
Medical codes support the claim for services that you submit to a patient’s insurance provider. The financial operations of medical practices are ultimately driven by claims paid by patients and/or insurance companies. However, depending on the nature of the patient’s sickness, diagnosis, treatment, medical code selection, and dealing with potential claim denials due to coding problems, it might take weeks to months for a medical practice to get compensation. As a result, it is critical to provide the proper codes the first time in order to get the whole amount due as soon as feasible.
What is revenue cycle management?
The revenue cycle management includes everything from patient registration and medical record documentation to obtaining payment for services supplied to patients. Coding is at the heart of revenue cycle management, with reimbursement coming at the tail end. Receiving payment for your services is required to keep your business running. It is equally vital for the patient, who relies on payer assistance to cover the costs of their surgery.
Improve your coding quality for high-performing revenue cycle in healthcare
- Partner with the best Medical Coding Resources
Hiring qualified coders is one of the most effective strategies to enhance RCM medical coding.
RCM leadership is required to perform thorough due diligence, which involves the following checks:
- Coders are certified by authorized healthcare organizations such as AAPC and AHIMA.
- Coders are aware of their critical position in RCM, strive for quality assurance, seek ongoing education and training to stay up with changes in the healthcare environment, and learn from colleagues every day.
While this may appear to be a normal practice, maintaining the continual training and supervision of in-house coders is a time-consuming and labor-intensive process. Delay in investigating the option of outsourcing the process to firms that specialize in end-to-end RCM medical coding does more harm than good.
- Pay attention to your EMR Workflows
The number of charts to code is sometimes so big and intimidating that working refused claims are put on hold.
Working through rejections is a time-consuming procedure that requires study, rework, and resubmission – all under a strict deadline.
To avoid recurrent errors, it is critical to change the practice management system and educate coders on the laws and regulations.
Revisiting the coding workflow entails determining if your coding department is appropriately staffed to manage the burden, creating a task list and prioritizing tasks, and selecting who will work on which parts of the process (i.e., new claims, rejections, and corrections).
- Do not disregard the code compliance audit
Complete and precise coding results in a high-performing revenue cycle and guarantees government healthcare laws are met.
According to a Change Healthcare analysis, over $262 billion in claims were first refused in a single year, mostly owing to a lack of clinical information, with $28 billion in disallowed monies attributed to a lack of clinical documentation.
By ensuring that medical coding processes adhere to the specified norms and procedures, such denials that require further information for payment can be avoided.
A coding compliance audit reviews a certain number of charts per certified healthcare practitioner to ensure that the services provided and the codes entered are accurate.
As a result, conducting quality audits finds areas for improvement that cause revenue leakage, offers opportunities for training and workflow rectification, and speeds up claim reimbursement by minimizing denials.
Following the completion of the audit, providers must freely share the audit results and, if required, establish education and training programs. Furthermore, they must disclose any changes in coding compliance, particularly in unforeseen and unusual scenarios such as the COVID-19 pandemic, which has the potential to disrupt revenue cycle coding procedures.
- Ensure HCC and SDOH have always been on your radar
According to Deloitte4, a growth in value-based buying and at-risk payment models has increased interest in enhancing the health of the populations under management. As a result, correct coding for risk factors HCC Coding and SDOH collection is more important than ever. In 2021, providing excellent treatment, lowering costs, and avoiding revenue loss for healthcare providers involves leaving no stone unturned for a thorough deep dive.
To compute 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 (gender, age, etc.) and current health state to predict the patient’s projected healthcare cost for the year.
HCC coding helps clinicians to be compensated adequately and fairly for treating high-risk patients while offering value-based care.
Managers and leaders must thus ensure that every stakeholder knows the importance of accurate HCC coding in revenue cycle management. For example, clinicians must use the M.E.A.T criteria to describe the patient’s condition to the maximum levels of detail, making it easy for coders to assign the relevant codes.
Similarly, coding for social determinants of health (SDOH) enhances patient treatment and experience while lowering readmissions and contributing to a sustainable revenue cycle. SDOH are socioeconomic elements in the patient’s surroundings that may be classified into five categories: (i) economic stability, (ii) education access and quality, (iii) healthcare access and quality, (iv) neighborhood and built environment, and (v) social and community context.
Conclusion
It is critical for healthcare providers to boost their bottom line by guaranteeing adequate payments with accurate paperwork and coding. Working with a code solutions firm, such as Oriental Solutions, is one approach to giving providers on-demand expert services like coding, coding education, and audits.
Our distinct service delivery combination of local and foreign resources offers a cost-effective option for any Revenue Cycle Management team aiming to boost ROI.
Our experienced revenue cycle coders are specialists in ICD-10, CPT4/HCPCS, MS-DRG, and other coding standards, providing high-quality revenue coding services (95% or more accuracy) and prompt payer submission.
Furthermore, our 3-Tier Quality Assurance Process finds and corrects any/all faults to reduce refused claims. We provide a 24-hour turnaround time as part of our offshore medical coding services, as well as weekend and holiday coverage at no extra charge if needed.
Maximize your revenue. Contact Oriental Solutions for expert coding services and boost your bottom line today
