Sunday, June 16, 2024

6 Ways to Improve Medical Coding

Must read

Ways to Improve Medical Coding at Your Medical Practice

Improve medical coding is an essential part of the claim cycle and is required for the claim processing. However, incorrect coding may harm your practice in a variety of ways, including lost income, possible overpayments, and accusations of manipulating reimbursement regulations. Inaccurate coding may also cause personnel issues when the need for follow-up on claim rejections rises.

Today in this article, we are going to discuss another important topic, ways to improve medical coding. So this article helps you to improve medical coding as well as your medical coding practices. So here we go!

Improve Medical Coding

The most effective strategy to reduce growing business costs in your healthcare profession is through effective coding. The procedure and diagnostic codes used to submit payment claims determine how much your providers get compensated for the job they accomplish. As a result, it is critical to ensure that you improve medical coding techniques are customized for success.

Finding strategies to cut costs while increasing revenue is critical if you want to keep your medical business economically sustainable. With company expenditures on the rise, effective and improved medical coding practices are more crucial than ever. In addition, medical offices must ensure that their coding systems are optimized for business success.

Suppliers’ discounts and employment tactics are fine, but if you want to manage growing business expenses in a significant way, excellent coding is your best chance. The procedure (CPT) and diagnostic (ICD-9) codes used to submit claims for reimbursement determine how much and whether your providers get compensated for their services. As a result, it is critical to ensure that your front- and back-office coding methods also become successful.

This includes taking actions to reduce rejections, training to verify you are not under coding (a typical issue), and preparing your objections to appeal denied claims as required. As the profession converts to the increasingly complicated ICD-10 coding format this fall, such initiatives may make or break your bottom line.

Improve medical coding at your medical practice

Here are six ways to help you start coding more efficiently in your medical practice. So let us go over those ways one by one.

1. Learn from denied claims

If your practice’s medical claim rejection rate exceeds 5%, you must address the problem. The most typical causes for claim rejection include missing information, poor documents, code problems, and delayed submissions. To avoid denied claims, excellent communication among your medical billing and coding professionals and healthcare professionals is required to make sure the correct codes are entered on claim forms. Maintaining open channels of communication among your organization and insurance can be just as useful.

Insurers also regularly decline claims for treatments deemed “not medically required.” Because either the diagnosis was unrelated to the procedures or because they are only paid at specific rates. In this instance, checking insurance coverage and permissions before each visit might help reduce the number of refused claims. To reduce coding mistake rates, you must be diligent at all times, from scheduling appointments to filing claims.

Specific payers are selective than any others. Therefore, it pays to determine people who refuse payment the most frequently so that you can verify their claims are correct the first time. However, the procedure of resubmitting is time-consuming. According to the MGMA, most practitioners pay an average of $25 to $30 to resubmit a revised claim.

2. Enhance Patient Communication

Being aware of your rules and successfully expressing them to your patients will go a long way. Your professionals can work collaboratively with patients to verify proper insurance details, properly describe the coverage policies of each plan, and file claims precisely if they have a better grasp and communication of payment policies. It is also critical to be upfront about your prices. Constantly inform your patients how much medications and procedures charge to decide whether they can afford it and if their insurance reimburses it. Verify their coverage before their visit so that you may include all charges in your conversation.

3. Verify that all employees get proper training.

The other way to improve medical coding is, verify your employees have proper training in medical coding. One of the most effective strategies to improve your practice’s coding is to give additional training to those who work with billing and coding. While your clinic is most likely already familiar with ICD-10 standards, it might be difficult to keep up with a completely new coding system.

To guarantee that you receive the most payment for your services, healthcare professionals and other staff members must learn to follow new documentation and coding standards and requirements. In addition, continuous learning for coders and other of your employees can aid in the prevention of basic errors that can lead to coding errors and under-coding.

4. Audits can be used to enhance coding accuracy.

Medical coding compliance audit can bring quality concerns to light to be corrected as soon as possible. When conducted with the proper goal, manner, and frequency, medical coding audits can enhance coding accuracy when criticism is delivered with providers and coders. So here’s a recommendation inside a tip: never, ever let your coders believe that an audit is a bad (or worse, punishing) activity. When you audit programmers to continue professional development, the good results flow both ways inside the revenue cycle.

Determining that medical coding methods follow to payer code can help avoid “soft” rejections that need more details for payment. In addition, internal audits of these procedures can reveal regions or types of instances that are causing revenue losses due to poor practices, processing difficulties, or even insufficient training.

Collaboration between auditors, coders, and suppliers may pay off handsomely. Audits may be generally helpful if both the auditor and the coder/provider view them as an opportunity to learn. An auditor, particularly with professionals, can gain a better insight into the provider’s thought processes and a better comprehension of the medical industry. Working with programmers requires a positive approach and mutual respect. When this relates to the complexities of medical coding, neither doctors, coders, nor auditors understand it, which is why continuous learning is essential.

5. Keep an eye out for trends in denial and rejection.

If you see a rise in denied and rejected claims in your medical practice, it’s critical that you assess what’s occurring on and discover any trends. For example, claims with one insurer may be denied more frequently than claims with others. You may also discover that a particular diagnostic code causes more claims to be denied or that insurance requirements and payor-specific modifications go unreported, resulting in more rejections. Identifying the cause of the rise in denials and rejections will assist your practice in revising policies and processes to raise your clean claims rate more quickly.

6. Keep up with the latest trends in healthcare.

CPT, the health common procedure coding system (HCPCS), and ICD-10 are all updated on a yearly basis. Your coders must be trained and educated on all coding-related changes, but more than ever, they must grasp the impact of value-based care and newer reporting requirements on patient care costs. For example, hierarchical Condition Categories (HCC) is a risk adjustment methodology that has been available for years but has gained traction when Medicare Advantage Plans began to need risk adjustment factor (RAF) ratings for payment.

Medical coding was transformed by electronic health records, which brought the paper-intensive procedure into the digital era. While the EHR system remains essential to the medical coding process, new technologies have arisen to increase the quality and reliability of medical coding. Computer-assisted coding (CAC) systems, for example, are software packages that can evaluate medical records to determine the relevant medical codes for clinical information.

More articles

I am a medical biller, a blogger and have 20 years of experience in medical billing, medical billing management, and medical assistant. My background includes positions as a clinical medical assistant, medical records technician, medical office manager, biller, and coder. I am certified by the American Academy of Professional Coders (AAPC) as a Certified Professional Coder (CPC) and by the Practice Management Institute (PMI) as a Certified Medical Office Manager (CMOM). As an office manager/biller/coder, I was a member of the Michigan Medical Group Managers, Michigan Medical Billers Association. I also served as a committee member of the Michigan Osteopathic Association of Practice Managers Education Committee.

Latest article