Revenue cycle management relies heavily on accurate medical coding to guarantee that claims are processed correctly and that the proper amount of money is reimbursed. That is why it can impact every step of the revenue cycle if done incorrectly.
Since last year, the healthcare provider’s revenue cycle has been most vulnerable due to clinical documentation and coding deficiencies. In 2020, the COVID-19 pandemic and advances in value-based reimbursement were expected to be the most significant threats to income.
Every medical coder began working remotely because of the severity of the COVID – 19 scenarios. This was one of the obstacles they faced in ensuring the quality of the codes they produced. Regardless of where coders are located, healthcare providers can use proven tactics to boost coding quality and assure appropriate reimbursement.
In this article, we share the best practices in healthcare coding for improving medical coding quality and maximizing reimbursements.
- Ensure Accurate Coding
Healthcare Revenue Cycle Management begins with accurate medical coding. Correct coding activities are not only required by law but also significantly reduce the number of rejected or denied claims, allowing providers to get the maximum amount of money for the services they provide.
When discussing denials, consider that, on average, resubmitting and reworking denials cost $8-10 for each claim. The reported inappropriate payment rate for Medicare FFS programs was 9.51 percent. According to MGMA, AAFP, and CMS, 90% of all denials might have been avoided.
To maximize collections, we suggest that precise coding must be completed before submitting a claim.
- Be Competent While Documenting
Don’t skimp on the documentation! Restrictive and “economical” documenting a patient-physician encounter’s entire sequence of events might seriously impair coding precision. A patient’s care may be billed incorrectly because of a lack of complete documentation.
As a result, physicians must document all aspects of patient treatment in their medical records. This includes the time spent on a patient’s visit, any examinations or treatments carried out, and the reason for their visit.
Implement a CDI (Clinical Documentation Improvement) strategy. In addition to improving data quality and resulting in proper compensation, a CDI program can also enhance patient healthcare outcomes.
Engage the services of a clinical documentation specialist to assist you in streamlining the documentation of your medical records. A CDI professional can strive to ensure that doctors, transcriptionists, medical coders, and the healthcare team are doing their jobs to the same high standard of accuracy and quality. If you have any questions or concerns about documentation, a CDI specialist can help.
- Ensure That Only Certified and Educated Coders Are Employed
A coder’s coding talents and certification work hand-in-hand in establishing and verifying their expertise. Some certified medical coders have a solid understanding of interpreting a medical language from reading clinical paperwork into codes that create links between medical needs and the therapy or services delivered for that necessity.
As a result, these codes are used by insurance companies to decide how much money they should pay for the services provided. As a result, coders should be well-versed in the significance of conveying medical necessity and reporting services through the codes they assign for each encounter.
- Submit Clean Claims
You may wonder how much energy and cash you spend on reposting claims as an independent practitioner, and the price goes up directly to the volume of rejects. So, if you want to improve your billing and collection processes, you should start by making sure that you are submitting accurate claims from the start.
Even though there are a lot of talks these days about the need for clean claim submission, the market rate of First Pass Acceptance (FPA) of claims falls between 79-85 percent.
- Make Sure You Know How To Document Telemedicine Practice Properly
The global pandemic has resulted in a surge in the use of telemedicine technologies, which has improved patient access and increased patient happiness. Healthcare businesses need to keep an eye on the newest CMS modifications and rethink their telemedicine reimbursement strategy in light of these changes.
Coders must report telemedicine services from a remote location using the Place of service code 02. When remote healthcare services are provided via synchronous patient-provider communication, insurers may also require modifier -95.
- Correctly Code Transitional Care Management (TCM)
There are higher rates of denial in TCM. A two-day follow-up with patients who have been released from the hospital is essential for care coordinators to avoid TCM denials by obtaining precise information from them by phone or in person. ADT feeds, discharge summaries, and smooth data integration into the EHR management must all be appropriately documented. This will make it easier for administrative employees to interact with outpatients.
For high-complexity TCM instances, ensure that you provide the payer with precise and complete documentation, starting with the date of discharge, call information (such as the time and date), a synopsis of the interaction, and more.
- Check Your Insurance Policy
To assess insurance coverage & patient responsibilities before the appointment, you should verify eligibility and pre-authorization on some checklists.
These insurance-related facts should be checked ahead of time since failure to do so could result in delays or denials of claims and a decrease in customer satisfaction and non-payment.
- Keep Tabs On Important Metrics
Services like fast and detailed data and analyses provided by healthcare revenue cycle management businesses might be helpful. To make sound business judgments from these data, clinicians must understand a few things, and doctors must always keep these crucial ideas in mind.
- Evaluate Medical Billing Laws and Regulations regularly
Know current medical bill standards to ensure proper medical billing and coding. Staying current on the latest regulations is essential for streamlining the application process and reducing the likelihood of rejections and medical billing changes.
The cash flow of your medical business can be adversely affected if you do not keep abreast of changes in medical billing regulations.
There have been numerous coding updates as a result of the pandemic scenario. Care providers must be well-versed in these new developments to keep on top of the medical billing and coding process.
Using the newest billing software, industry best practices, and precise billing and coding handled by trained and experienced coders are all advantages of working with an effective healthcare revenue cycle management business.