Role of medical coding in the future of healthcare
The healthcare industry in the US is constantly changing. The perception of a lack of correlation between healthcare costs and quality has led to the transition from the fee-for-service model to the value-based care model. Further multiple headwinds such as declining reimbursements, the rising cost of hospital care due to the increase in the cost of supplies post-COVID, and the great resignation are leading to a problematic situation for healthcare decision-makers. Hospital margins are at their lowest point in 20 years. Yet, they are finding it difficult to find both clinical and administrative personnel.
Medical billers and coders are the lifeline of the complex reimbursement processes, i.e., the revenue cycle. The medical codes serve as the common language for healthcare providers and payers and drive the rules around reimbursements. Therefore, experienced medical coders are always in demand. On the other hand, medical billers work on revenue cycle component processes such as patient experience, claims submission, and denial management. Medical coding is also the anchoring discipline for defining the quality of care.
Healthcare administrative talent will be in short supply for many years, and medical billing and coding offer lucrative career options. This blog discusses the importance of medical coding, the career opportunities it provides, and how medical coding will play a critical role in defining the quality of care.
Understanding the basics of medical coding
Medical coding involves the translation of medical diagnoses and procedures into industry-standard codes. These industry-standard codes serve as the common language between providers and payers. The process is essential for the healthcare payers to understand the disease or ailment the patient has and the procedures taken by the medical practitioner. Against these procedures and illnesses, the payers have a prescribed reimbursement amount. As the process of medical coding requires a good understanding of medical terminologies, it is a very specialized field requiring intense training and certifications.
Importance of medical coding
Beyond reimbursements, medical coding can be an effective mechanism for understanding the quality of medical care provided. We look at some of the factors that make medical coding processes integral and critical to the future of healthcare delivery:
Aging population. With the population in the US aging, the demand for medical care, especially for chronic healthcare conditions, will surge. Increased demand for medical care translates into increased demand for medical coders and billers.
Declining reimbursements and increasing claim denials. Healthcare insurers have reduced reimbursements for medical care over the last few years. They do this primarily by denying claims that do not have the right medical codes. Efficient medical coders can ascribe the right medical codes, ensure better first-pass resolution rates, and accelerate cash flow.
Increasing coding complexity. The rise of telehealth, hospital at home, and preventive care mean that the medical coding complexity has increased, requiring specialized coders updated with the latest guidelines.
Coding for healthcare quality measures. The concept of value-based care anchors on the ability of medical codes to define the quality of care and get incentives from federal programs.
The complexity of delivery models. ASC (Ambulatory Surgery Centers) or outpatient settings are increasingly responsible for more complex surgeries. Coders must know these complexities and the associated reimbursement rules in ASC and Outpatient settings.
A knowledgeable coding workforce can help healthcare institutions with timely reimbursements and help achieve targeted quality measures.
Careers and entrepreneurial opportunities in Medical Coding
Medical coding jobs offer a great career with opportunities to advance to managerial and leadership roles in the revenue cycle function. While both medical billing and medical coding positions provide good pay, opportunities in medical coding are more lucrative because of specialized skills and certification requirements. The market for talent is highly competitive, and many organizations offer flexible working schedules and remote working options.
For entrepreneurs, the revenue cycle field offers a multi-year opportunity to build great businesses as the demand for medical billing and coding skills will increase significantly over the years. Some innovative companies are also beginning to offer computer-assisted and autonomous coding solutions.
Preparing for a successful medical coding career
Medical billers and coders run revenue cycle processes that move the money in the business of healthcare. Of late, medical coding also drives the measurement of quality in healthcare and is the force behind value-based reimbursements. Medical billers and coders must be accurate, responsive, and organized to address each claim and leave no stone unturned. They must prepare for the future changes expected in the industry, such as ICD-11 implementation.
Claim denials are rising, and medical billers and coders must collaborate to understand the reasons to make amends and refile claims to get reimbursements. Documentation and policies can vary from insurance to insurance, state to state, and by specialty. Non-adherence can lead to claim denials. Hence, the revenue cycle team must be diligent and always curious about the denial reasons to define ways to reduce claim denials and maximize reimbursements.
Medical billers and coders can get help from thousands of online resources that can help them prepare for a successful career. CPC certification from AAPC and CCS certifications from AHIMA can be excellent places to begin your certification journey.
Whether you are looking for a career in medical coding or embarking on an entrepreneurial journey, the field has immense potential for success.
Outsourcing and Offshoring in Medical Coding
Outsourcing and offshoring the Medical Coding process can give you access to certified coders. The quality of medical coders in offshore locations is excellent, and their work can help you reduce denials, improve reimbursements, and plug revenue leakage. Healthcare providers and revenue cycle aggregators must choose the right service providers to improve the coding quality and achieve market-leading outcomes.
Below are the benefits of outsourcing and offshoring Medical Coding processes:
Scalability and access to experienced Coders. With the growing demand for medical coding, you require access to a large pool of coders with experience in inpatient, outpatient, emergency department, and risk adjustment coding. Offshoring can give you access to the labor pool.
Enabling doctors to focus on patient care. Doctors share the responsibility for clinical documentation and coding with medical coders. High-quality medical coding staff can reduce the administrative burden on doctors.
Coding quality – improved accuracy, decreased DNFB and accelerated cash flows. High-quality medical coding ensures that the first-pass resolution of claims is higher and leads to accelerated cash flow realization. Experienced medical coders can plug revenue leakage by identifying discharges, not final billed cases, and reduce revenue leakage.
Improved physician satisfaction. Seasoned medical coders can help improve clinical documentation leading to improved physician satisfaction. Rather than addressing individual claims for clinical documentation issues, they aggregate issues by physicians and by facilities to create scalable clinical documentation improvement programs.
Cost Efficiency. Offshoring your medical coding programs can reduce clinical coding costs by over 40-50%.
While the benefits of medical coding outsourcing and offshoring are many, successful programs utilize mature suppliers with great delivery leaders, robust processes, and excellent technology tools for collaboration.
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