Medical billing and coding are the most important parts of the revenue cycle. Making errors in these processes lead to substantial revenue losses and payment delays. Similarly, healthcare facilities need to prevent denials from insurance payers because it adversely affects the revenue cycle process.
The studies and analytics show that billions of dollars are lost in the form of claim denials and the major reason behind denials is coding errors. Medical practices and healthcare providers cannot afford to take risks of losing money due to billing and coding mistakes. So, it is essential to submit clean claims for avoiding delayed reimbursements and optimizing revenues.
Coding errors in the form of upcoding and unbundling harm the revenue cycle process and the billing staff should avoid it. Higher reimbursements and streamlined cash flow depend on the billing practices providers follow.
- How to Improve Your Coding Accuracy?
- Implementing a cost-effective method of improving coding accuracy
- Best Practices to Increase Medical Billing and Coding Accuracy
- Free Guideline and Strategies for Improving Coding and Reimbursement
- 6 ways to boost revenue by improving coding and compliance:
How to Improve Your Coding Accuracy?
Healthcare providers can work on their financial cycle to make forecasts and avoid spending time on resubmissions. So, having a proactive approach of denial management helps to reduce denials and accounts receivable. Hospitals and medical practices should avoid coding errors to achieve an efficient RCM process with Medcare MSO Billing Services.
Here are some areas where providers and their staff should pay attention to avoid claim denials and get a smooth revenue cycle:
Stay Updated with the Coding Guidelines
Medical codes define the procedure, treatment, and service physicians provide to the patients. The insurance payers use medical codes to understand the procedures and adjudicate claims for reimbursements.
In addition, the healthcare industry evolves and there are many changes physicians and medical practices need to cater to. As a result, providers need dedicated billing and coding staff, whether in-house or third-party, to ensure timely claim submissions to payers. Also, it is necessary to comply with the payer guidelines for getting reimbursements on time. ICD-10, HCPCS, CPT, and NDC are some of the prevalent coding systems.
Due to ever-changing coding systems, medical coders find it challenging to submit clean claims with accurate codes. In today’s healthcare industry, coders need to electronically submit claims and it is essential to have complete knowledge about codes and modifiers.
When a software is used for coding, it automatically marks the incorrect code as the technology is updated with the latest guidelines. So, it is advisable to use technology platforms for coding and take help of professional and certified coders for submitting claims to payers.
Using Latest Health Information Technology for Efficient Coding
Health information technology has led to more efficient coding systems. Dynamic panel data (DPD) specifications consistently estimated parameters under fewer assumptions than ordinary least squares (OLS) and fixed effect (FE) panel data models. Serial correlation information is in the error term, not the estimated model.
A dynamic model must be specified and estimated to solve this problem. The DPD method can estimate the equation of interest using levels and differences specifications with appropriate lags of levels and different variables as instruments. Simultaneous estimation reduces finite sample bias and improves precision. Thus, dynamic panel data analysis examined IT’s impact on the CMI.
Here, i is hospital, t year. yit is the log of CMI, yit−1 is the lagged term of the log of CMI, lit is the log of total labor, kit is the log of total capital, ITit is the log of information technology investment, t is the year effect, and αi is the hospital fixed effect. In the equation above, θl, θk, and γ are the input elasticities for each respective input.
Cost Benefit Analysis of an Initiative to Increase Billings Accuracy
The process maps detailed administrative tasks for each step. The analysis required time estimates and personnel costs for each step. Physicians’ billing costs were estimated separately because the billing organization didn’t know.
Management provided industrial engineering productivity standards for most process map steps. Manager interviews and supervisory conversations were used to estimate productivity standards for the few steps without such standards. Respondents were not asked for payer-specific data, so the results represent typical payer-agnostic costs for each billing activity.
The billing organization also pays corporate and divisional costs like human resources, professional development, utility bills, information technology cost allocations, and building depreciation. These overhead costs were allocated by organization processing time (in other words, on a per-direct-labor-minute basis, excluding physician billing times because physicians are not supported by these administrative functions).
Primary care visits, emergency department visits (discharged, not admitted), general medicine inpatient stays, ambulatory surgical procedures, and inpatient surgical procedures were estimated using the model described in the previous sections.
The analysis “followed the bill” by documenting revenue cycle activities needed to bill for each of the 5 encounter types. Each encounter’s revenue cycle billing cost was the sum of all these activities’ personnel costs and divisional and corporate overhead. Direct, support, and supervisory labor comprised total personnel costs.
Primary care visits generate a single professional and facility bill. Other physician visits incur professional and facility (hospital) bills for health system services. In the latter cases, episode costs included professional and hospital claims processing costs.
The cost-accounting model was created in Microsoft Excel using typical resource use estimates at each process map step. The model did not include variability because there is concern that variation in this multistep process is likely correlated in some unobservable manner, resulting in significant multiplicative errors.
The base-case analysis considered only the billing organization’s annual certified EHR system cost allocations. A second analysis examined the impact of including a 6-year amortization of the full published costs of acquiring and implementing the health system’s certified EHR system in overhead. This analysis assumes that replacing the non certified electronic record system was solely for billing.
Base-case overhead costs were based on direct labor costs. In a sensitivity analysis, overhead was allocated per-bill. Billing costs for professional services (or global billing in primary care) were estimated and compared to estimated physician revenue for each encounter type to estimate the percentage of physician revenue devoted to billing. Primary care physicians’ annual billing costs were estimated using the academic medical center’s standard clinical work schedule and billing cost per visit.
Implementing a cost-effective method of improving coding accuracy
This study was designed to assess our current coding inaccuracies and develop a cost-effective intervention to fix them. Poor, ambiguous, or un-codable clinical documentation, subjectivity, and clinical coder dependence on discharge summaries are the main causes of coding accuracy, according to the literature.
We hypothesized that better codable data would reduce coding errors. We added a clinician-provided WHO International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) code to the patient’s discharge summary to improve primary discharge diagnosis coding. This would have eliminated clinical diagnosis ambiguity and coder subjectivity.
PDSA cycle (baseline study)
The first cycle randomly selected 40 fully coded acute surgical episodes from January to February 2022. Each patient episode was analyzed. The team analyzed each case using the same data from the initial coding episode.
We wanted to know how common coding errors are in our practice and why. The monthly surgical departmental meeting shared the results. Clinicians should include an ICD-10 primary discharge diagnosis in the electronic discharge summary to reduce coding errors. Clinicians were introduced to the WHO website to find the appropriate ICD-10 code.
Junior clinicians (foundation year 1 doctors) confirmed WHO website usability. Clinicians were advised to enter the most relevant code for ambiguous or closely related ICD-10 diagnoses. Clinicians were better at making clinical judgment calls on the best diagnosis than coders, who are not medically trained and rely only on archived information.
The week’s on-call surgical consultant would remind clinicians to enter the ICD-10 diagnosis at morning handover to ensure compliance. To promote the project, doctors’ offices and surgical wards displayed posters.
Best Practices to Increase Medical Billing and Coding Accuracy
- Keep up with the ever-evolving coding standards.
- Improve the precision of medical billing and coding through the use of automated claims management.
- Reduce wasted time by getting rid of inefficient processes.
- Make changes to the claims section that are unique to your needs.
- Improve your medical billing and coding by upgrading your database software.
- Verify all claims twice before submitting them.
- Inaccuracies in medical coding can be found in the claims management process if it is audited.
Free Guideline and Strategies for Improving Coding and Reimbursement
The Medical Group Management Association advises practices to file accurate claims that meet reporting guidelines, track denials, and file appeals quickly to maximize revenue (MGMA). Your front desk should handle insurance coverage issues, but some reimbursement issues can be solved by better back office organization and assignment of duties.
6 ways to boost revenue by improving coding and compliance:
1. Designate an in-house claims tracker
If your staff allows, assign one person to identify and flag claims that are approaching the deadline for resubmission or appeal of denied claims and ensure that any additional documentation is updated and ready to send. Resubmitted claims should be monitored to ensure that the payer received them on time and that they are reimbursed.
2. View denials as a learning experience
MGMA recommends taking time to review denied claims to prevent future denials. In the absence of pre-submission software, your staff may need to pay closer attention to the following common denial reasons:
- Missing pre-authorization or signed Advanced Beneficiary Notice of Non-coverage.
- Many E&M codes depend on whether the patient was new or established.
- Missed deadlines—providers have deadlines, so pay attention.
- Every patient visit should verify insurance coverage.
- Non-covered items deny benefits. Before starting treatment, check benefits.
- Do any payers frequently deny? If so, send them clean claims the first time.
- Code with doctors and others.
Having a coder write down information and compare notes with providers may reveal that physicians and others omit critical information in notes, such as reading x-rays or lab reports, which will be under coded and cost the practice money. At monthly staff meetings, coders can review notes with providers to improve documentation and coding accuracy.
3. Maintain coding regulations and resources
The AMA annually revises its CPT books for additions, deletions, and revised guidelines to comply with CMS ICD-10 requirements. For compliance and accurate reporting, your practice should use modern tools.
4. Review provider or clinician notes before coding
Coders must check a provider’s notes for missing information, especially if they only read the headers. The body may have more diagnostic information that would help choose the best code.
5. Partner with an experienced medical claims services company
Third party outsource medical billing and coding companies have been offering medical billing and coding services, AR recovery services, medical billing and coding services for DME, and to healthcare facilities of all sizes. It offers RCM analysis to providers assisting them to know where their practice lacks.
Partnering with medical billing and coding services providers helps healthcare organizations to thrive financially and achieve a high-performing revenue cycle.
Hi, I’m Kim Keck! Born in Texas, USA. I have completed my Bachelor of Business Administration in Healthcare Management from University of Texas. Right after completing my degree in 2011, I started my job career as an Accounts Receivable in a medical billing company.
Now, with more than 15 years of experience as a medical biller and revenue cycle manager, I am on a mission to serve the medical billing industry with my vast knowledge and years of expertise.