5 Reasons To Improve Medical Coding Quality

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NEC-Medical-137 - Photo by: NEC Corporation of America

Maintaining accurate and quality medical coding is a fundamental aspect of effective revenue cycle management essential for submitting valid claims and receiving fair payment. As a result, any component of the revenue cycle could be affected by poor implementation.

Clinical documentation and coding have emerged as the healthcare provider’s primary revenue cycle weak spot during the previous 12 months. Similarly, in 2020, the significant risks that result in decreased revenue are expected to be the COVID-19 pandemic and increases in value-based reimbursement.

Medical coders have started working remotely due to the COVID – 19 outbreak, which poses a difficulty in code quality. Whether coders are located on-site or off-site, healthcare providers can adopt professional tactics to improve coding quality and assure appropriate compensation.

In this writeup, we will discuss the top five reasons for enhancing the quality of your medical coding company:

1. To Concentrate On EMR Workflows

Claim denials require time-consuming research and re-submission. If you examine your claim denial records, you may find instances of coder error that have occurred repeatedly.

Remedial Training

Review coding rejections with your code team regularly, at least once a month and ideally twice a month. Determine the cause of the top 5-10 denials due to incorrect coding. 

Inaccurate clinical documentation or a lack of familiarity with the proper codes for a certain treatment are common causes. You may solve many of the problems you’re having with the coders by having a brainstorming session to raise their awareness of the proper codes.

Coding Team’s Workload

The industry-wide lack of competent medical coders has become chronic. Because of a dearth of competent personnel, the Medical Coding department has set unachievable goals for its output. 

Businesses often ignore the problem of coder burnout. By properly sizing the coding team, you can ensure that everyone on the team is working at a reasonable pace, that productivity objectives are achievable, that morale is high, and that quality of code is high.

Configuring Systemic Checks Within Your Programming Workflow

Learn how your revenue cycle software works, and if at all possible, implement automated checks to catch any recurring mistakes. Stopping these blunders and speeding up cash flow is made possible by validation checks driven by the system.

2. To Properly Employ Modern Technology

The introduction of EHR systems has resulted in a sea change in the medical coding industry. There was a significant shift caused by EHR software since it digitized a formerly paper-based procedure. The electronic health record (EHR) system is widely regarded as the key factor in the success of the medical billing process. However, other technologies also enhance the quality and accuracy of medical coding.

Computer Assisted Coding System (CACS)

The purpose of a computer-assisted coding system (CACS) is to streamline the process of assigning medical diagnoses and procedural codes to terms in clinical documentation by performing an automated analysis of healthcare documents. The American Health Information Management Association (AHIMA) claims that a CACS is preferable to manual coding due to its many advantages.

Advantages of CACS:

  • Gets rid of unnecessary paperwork
  • Aids in more precise and timely coding
  • Higher levels of contentment among coders
  • Detection of Blanks in Clinical Records
  • Accurate medical billing at a faster pace
  • Enhanced efficiency in the coding process
  • Increased income from more accurate billing

Current and prospective medical coders must be certified by a reputable organization like the American Health Information Management Association (AHIMA) or the American Academy of Professional Coders (AAPC) to ensure high-quality coding.

3. To Perform Code Compliance Audits On An Annual Basis

Coders contribute to healthcare facilities’ quality compliance initiatives by deciphering patient records using standardized codes and coding norms.

Revenue cycle operations can be streamlined, the frequency of claim disputes and denials reduced, and compliance with federal and state healthcare rules ensured through coding compliance audits. It is impossible to have a successful revenue cycle without accurate coding.

Reducing the need for appeals by verifying that medical coding is being done under the established norms and processes.

Each certified medical coder’s coding skills and clinical documentation quality are audited using a statistically significant sample of patient records in a coding compliance audit. Since in-house knowledge gaps exist, many facilities are now outsourcing annual coding compliance audits and continuous Coding Quality Audits.

4. To Provide Instruction And Training

Audits of coding quality can reveal important opportunities to enhance medical coding accuracy. Audit results are meaningless if there isn’t a solid training and education program in place.

Improve developer output and retention by encouraging continued education. As quickly as possible, providers should update coders on audit results and any modifications to coding compliance. 

If programmers are made aware of problem areas, they can make quick changes to their processes to raise the bar on coding quality. Coders are more likely to be on the same page about coding compliance changes if they can talk to one another about them, especially when something unexpected arises.

teaching school

5. To Initiate Communication Mediums

Internal and external coding quality audits both provide valuable insight into how to enhance medical coding accuracy. Providers should update coders as quickly as possible on audit results and any necessary adjustments to coding compliance. 

By discussing trouble spots, coders can quickly change their processes and raise the bar for their work. Coders need to be on the same page about changes to coding compliance in the face of the unexpected. Therefore, it is good practice to keep everyone in the loop.

The COVID-19 outbreak highlights the need for the coding community to improve its procedures in light of the ongoing threat posed by viruses and other potential disruptions. Leaders should be proactive about how to standardize processes inside their businesses when a new ailment is looming on the horizon across the country.

In order to create real change for coding quality improvement, audit data should be shared across the revenue cycle and with physicians. Given the ripple effect that coding has on the rest of the revenue cycle, it makes sense to involve key players in the case management process at every step leading up to coding.

In the end

Quality medical coding is essential for generating noteworthy income. The important things you really need to accomplish are verifying credentials, inspecting quality, and quality coaching. As a result, a good health tech company will provide your organization with superior medical billing and coding services that boost both income and the quality of care provided.