Tips to Improve Medical Coding Quality
Medical Coding has a significant impact on revenue cycle performance, so taking the time to analyze your coding department is indeed mandatory. It can help you find lost dollars due to discharges not fully billed or reduce coding-related denials. Medical Coding analytics by facility or provider can help you identify critical clinical documentation issues that can help you improve coding quality.
Your revenue cycle is an ongoing operation. Many of the Coding related issues that you identify in the first pass of analysis and corrections can give you high-level fixes. However, there is a need for ongoing investigation of your coding quality and making structural corrections so that the identified issues do not resurface.
We outline below some of the points from our experience in building high-quality coding programs and hope that these recommendations will positively influence your revenue cycle performance.
1. Pay attention to HCCs and SDOH
Valid Coding for risk factors HCC Coding and Social Determinants of Healthcare (SDOH) capture has become more critical than ever before.
HCC Coding
The Centre for Medicare and Medicaid Services (CMS) authorized the use of Hierarchical Condition Categories (HCC) coding to calculate the reimbursement under Medicare.
HCC codes examine a patient's information, such as age, gender, and current health status, to calculate risk adjustment factors that determine the patient's expected healthcare expenses for the year. HCC coding allows providers to receive fair remuneration for treating patients with higher risk while providing value-based care.
Physicians must record the patient's condition to the highest levels of precision using the MEAT ( Monitoring, Evaluating, Assessing, and Treatment) criteria, making it easier for coders to allocate the correct codes.
Social Determinants of Health
Similarly, Accurate Coding for the social determinants of health (SDOH) improves patient care and experience, reducing readmissions contributing to a healthy revenue cycle. One can look at the following five groups of SDOH - (i) economic conditions, (ii) educational background and quality of education, (iii) the access they have to quality healthcare, (iv) neighborhood in which they live, and (v) social strata and community context.
Medical Coders must use the "Z" codes to mark the SDOH. The "Z" codes can help a coder identify personal medical history, family medical history and conditions, drug abuse, etc. With ICD-10-CM, the coders must familiarize themselves with documented SDOH and code them. The current practice of not paying attention to "Z" Codes will not work in the long run and is critical to the success of the Medica Coding function.
2. Learn from Claim Denial Reports - Concentrate on EMR workflows
Working claim denials is time-consuming and involves research, revision, and resubmission. Analyzing your claim denial reports can help you identify repeated cases of errors committed by coders.
Editing your coding workflow by configuring systemic checks
Understand the functionality of your revenue cycle system and, where possible, create systemic validations that help you identify repeated errors. System-driven validations will help you arrest these errors and accelerate cash flow.
Remedial Training
Conduct coding denials review with your coding team periodically, at least once a month, if not fortnightly. Look at the top 5-10 coding-related denials and identify the root cause. Often, it may be because of a lack of understanding of the correct codes for a particular procedure or inaccurate clinical documentation in the facility. A brainstorming session can sensitize the coders about the correct codes and rectify many coding issues you currently face.
Coding Team's Workload
The shortage of qualified medical coders has reached chronic proportions in the industry. The lack of qualified resources has led to unrealistic productivity expectations from the Medical Coding team. Many organizations do not pay attention to this issue, leading to coder burnouts. Right-sizing the coding team can help you balance the coding team's workload, set realistic productivity goals, and improve morale and the coding quality.
3. Conduct Coding compliance audits – Annually, At Least
By using standardized codes and coding guidelines to interpret documentation, coders support the quality compliance programs of healthcare facilities.
Coding compliance audits can streamline revenue cycle processes, reduce the number of denials and claim disputes, denials and ensure adherence to federal and state healthcare regulations. Accurate Coding is the cornerstone of a high-performing revenue cycle.
Ensuring medical coding practices match the stated guidelines and procedures can contain the number of denials requiring additional information for reimbursement.
A coding compliance audit evaluates a statistically valid sample of charts for each qualified medical coder to check the codes recorded and the quality of clinical documentation. Many facilities are turning to third parties for ongoing Coding Quality Audits and annual coding compliance audits to get the expertise they lack internally.
4. Outsource Coding to a team of certified medical coders
Outsourcing Medical Coding processes, including ongoing Coding and quality assurance programs, is a well-established strategy today. Finding certified and experienced coders in these days of revenue cycle labor shortage can be difficult. Specialty-specific coding expertise can be even more challenging to find.
Further, outsourced Coding can help you accelerate revenue cycle innovation as the partner you employ can bring about many improvements in your coding workflow to improve the overall quality. The playbooks they have for different specialties and revenue cycle systems can improve the overall quality of Coding.
Conclusion
Whether you are facing a high rate of coding denials and not achieving best-in-class A/R outcomes or facing challenges in finding the right team of qualified coders, the impact of low-quality Coding shows very quickly in your revenue cycle metrics.
A team of certified coders can eliminate many of the issues resulting in a high number of coding denials. High-quality medical Coding is critical for accurate reimbursements. Medical Coding errors can result in claim denials, cause unwarranted compliance issues, and cripple your organization's finances.
Addressing coding quality issues requires a holistic relook at your coding team's structure, processes, and systems. Coding Audits can help you identify the issues, and a high-quality coding team can create a sustainable model for delivering high-quality coding services.
How can MBW help you?
At Medical Billing Wholesalers, we employ a team of certified medical coders accredited with many certifications from AAPC (American Academy of Professional Coders) and AHIMA (American Health Information Management Association). The certifications include CPC (Certified Professional Coders) & its variants such as CPC-H/CPC-I) and CCS (Certified Coding Specialist).
Highlights of our Medical Coding work processes include:
Proprietary workflow and coding audits. We utilize a proprietary workflow application that promotes random quality checks and audits a minimal statistical sampling of each coder's work. A knowledgeable and experienced coding auditor reviews this sample of work produced by a medical coder and reports back the errors in a structured manner
Adherence to work instructions. When we transition a coding process, we document the entire set of prevailing policies and procedures by collecting documents and conducting interviews with your expert coders. We refine this initially developed policies and procedures manual through ongoing quality calibrations and by analyzing the trends in coding denials to make course corrections. We train our coders on adhering to the latest available work instructions.
All our coders have life sciences backgrounds. The clinical experience of our coders helps us identify inaccuracies and inconsistencies in clinical documentation.
Periodic Refresher training. Coding operations leaders must learn from denial trends and conduct refresher training programs to align the team to the latest work instructions and updates.
Service Level Guarantees. We guarantee the best service levels for medical coding accuracy and turnaround time in the industry.
Plugging Revenue Leakage. Our coders can identify clinical documentation quality issues and provide feedback to clinicians on the procedures they have missed documenting and any other problems with the documentation. We take up iterative physician education programs to improve documentation quality and reduce DNFB cases to reduce missed revenue opportunities.
To learn more about our Medical Coding and audit services, Click here: MEDICAL CODING SERVICES
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