Hospital and professional coding usually begin when a doctor records information on services they provided to patients. It continues when that information is sent out as a charge capture to be assigned a billing code. Navigating this process is complex, especially considering that everything from a hospital room to tests and procedures must be billed for reimbursement.
Even durable medical equipment varying from a wheelchair to a ventilator to something as small as a nebulizer must have appropriate codes – often accompanied by a modifier – before assigning a billing code. That requires highly qualified professionals who have expertise in securing revenue opportunities and protect organizations against compliance risk and financial penalties.
Let’s take a look at how leveraging technology can impact coding processes and help coding experts ensure your organization’s optimal financial performance.
Recognizing challenges with the billing process
As the revenue cycle turns, information is sent from one department to another. When any miscommunication occurs or any details are left out, organizations risk a drop in revenue integrity. Insurance companies that are already financially strained deny a substantial percentage of claims based on mismatched procedures and ICD codes.
Many of these coding errors occur when coding professionals receive unclear documentation from physicians or hurried intake information. Sometimes these professionals may be unaware of coding updates. For instance, they may not know that 2 procedures are linked, so they bill each procedure with a separate code. This can set up each claim to be denied for unbundling.
Or perhaps a patient’s situation requires increased services, so the claim was billed with Modifier 22 and was not documented with justifiable reason. This often results in denied claims, causing additional administrative costs to be rebilled while sometimes claims are never paid at all.
Leveraging technology to resolve coding challenges
Hospital and professional coding experts can improve quality and ensure accurate reimbursement when organizations invest in technology. Take for instance the EHR system: it brought a “paper-heavy process into the digital age.” Its value to healthcare is indeed still vital, especially to the part coding professionals play in the revenue cycle. But it’s far from the only technology these professionals can leverage to achieve and maintain sustainable results in quality, compliance, and reimbursement.
Computer-assisted coding (CAC) solutions can help coding experts ensure the accurate and complete coding necessary for survival in today’s climate of value-based models. These solutions “analyze healthcare documents to identify the appropriate medical codes for clinical documentation in the documents.” They also increase efficiency, as “coders are freed from having to process routine, repetitious work” and can instead have more time to focus on ICD-10 updates and support physician ICD-10 education.
By working in partnership with such CAC solutions, coding professionals can also increase productivity and generate more revenue through their focus on more specialized patient care.
Maximizing AI-enhanced CAC solutions can take coding to the next level with its ability to “analyze the clinical documentation—charts and notes—and determine which codes are relevant to a particular case.” Veteran coding experts know that implementing and successfully maintaining the use of AI can only go so far though. Take for instance this concern from an 11-year expert:
“If it’s a surgery on a 75-year-old man with end-stage kidney disease, diabetes, and cancer, I have to code their medical history, what meds they are taking—it takes much longer. And the medical history codes are important because if the patient has multiple diagnoses, it means the physician is spending more time. Those ‘evaluation and management’ codes are important for correctly reimbursing the physician and the hospital.”
It comes down to leveraging technology for routine matters and then recognizing the expertise that coding professionals bring to the table. That expertise guides them as they work around the complexity of coding and multiple levels of variables that can impact quality care and reimbursement.
What coding experts can expect from technology
As coding professionals collaborate with organizations on appropriate technology implementations, their roles may very well evolve. The AI-enhanced technology allows coders to take on more impactful work in roles such as coding auditors and supervisors and opens opportunities for them to grow their knowledge, experience, and certifications.
Coding certifications provide financial incentives, as pay scales can increase. Growing into the responsibilities of a more specialized coder, an auditor, or a supervisor tasks experts with uncovering essential ways to improve coding quality. Having technology in place is the first piece of the puzzle of being able to successfully tackle that. It provides experts with a safety net for when the unexpected happens.
It also prompts communication expectations to evolve. From coding compliance updates to altered workflows that improve quality and accuracy and beyond, technology streamlines coding processes and how experts make informed decisions on comprehensive improvement strategy.
The bottom line
- Navigating the reimbursement process is complex. Highly qualified coding professionals secure revenue opportunities and protect organizations against compliance risk and financial penalties.
- Coding professionals need the appropriate technology to improve and secure revenue collection.
- Computer-assisted coding solutions is an example of such technology. It can improve billing accuracy, revenue integrity, and revenue collection.
- Technology indeed streamlines the reimbursement process, but there will always be a need for expert eyes to focus on more complex coding tasks.
Achieve and maintain sustainable results in quality, compliance, and reimbursement with Harmony’s coding experts. Kick-start your journey with us today:
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