The Medical Coding department is imperative as it greatly influences revenue cycle performance. Streamlining the operation for medical coding allows for the identification of missed revenue opportunities from incomplete billing of charges and helps in mitigating denials associated with coding errors. Utilizing medical coding analytics aids in pinpointing crucial clinical documentation shortcomings, facilitating enhancements in coding accuracy.

The initial analyses and corrections of coding-related issues often provide immediate solutions. However ongoing scrutiny and structural adjustments are necessary to prevent recurring issues. Drawing from our experience in developing top-notch coding programs, this blog shares below several insights aimed at enhancing your revenue cycle performance.

1. Pay attention to HCCs and SDOH

Accurate coding for risk factors such as HCC (Hierarchical Condition Category) coding and Social Determinants of Health (SDOH) capture has never been more crucial.

• HCC Coding

The Center for Medicare and Medicaid Services (CMS) has authorized the utilization of Hierarchical Condition Categories (HCC) coding for Medicare reimbursement calculation.

HCC codes analyze patient data, including demographics, health status, and other factors, to compute risk adjustment factors, which predict the patient’s expected healthcare costs for the year. This coding system enables providers to receive equitable compensation for treating patients with greater healthcare needs while emphasizing value-based care.

Physicians are required to document the patient’s condition with utmost precision, adhering to the MEAT (Monitoring, Evaluating, Assessing, and Treatment) criteria. This meticulous recording facilitates coders in accurately assigning the appropriate codes.

• Social Determinants of Health

Similarly, precise medical coding for Social Determinants of Health (SDOH) increases patient satisfaction while contributing to a robust Revenue Cycle. SDOH encompasses five key areas including economic circumstances, educational attainment and quality, healthcare accessibility, operating environment and community factors.

Medical coders employ “Z” codes to denote SDOH-related factors. These codes aid coders in identifying personal and family medical histories, substance abuse issues, and other pertinent details. With ICD-10-CM, it’s imperative for coders to be well-versed in documented SDOH and accurately assign corresponding codes. Neglecting “Z” codes is unsustainable in the long term and is integral to the effectiveness of the medical coding process.

2. Hiring the right resources

Medical coding is a demanding field that combines in-depth knowledge with the ability to apply it accurately. It’s not just about following a codebook – ensuring consistent implementation and evaluating current practices requires a skilled and dedicated coder. To streamline this process, healthcare organizations need to choose coders who can train others and adapt to changing standards as needed.

3. Frequent Guidelines and Coding Updates

Avoid costly mistakes! Ensure your EHR system reflects the newest coding updates. Regularly review and adjust coding standards to maintain complete transparency and keep your EHR/PMS fully compliant with the latest guidelines. By staying up-to-date, you’ll prevent incorrect coding applications that lead to higher claim denials.

• Reduced risk of penalties
• Improved accuracy
• Fewer claim denials

4. Conducting compliance audits

Accurate coding is the foundation for a financially healthy healthcare practice. Coders play a vital role by using standardized codes and interpreting medical records correctly. They also need to uphold the quality standards set by the practice.

Regular coding audits are essential. These audits examine samples of a coder’s work to ensure the quality of the medical records and identify any coding errors. Many healthcare facilities leverage external auditors to benefit from their expertise and get a more objective assessment.

Ultimately, by streamlining the revenue cycle through coding compliance audits, healthcare providers can significantly reduce claim denials, leading to improved financial performance.

5. Accelerate your Documentation process

Clear medical records are the key to efficient and accurate coding, which means higher reimbursements for your practice. A Clinical Documentation Improvement (CDI) specialist can help you achieve the level of detail and accuracy you need to streamline coding and maximize your revenue.

6. Adhere to EMR workflows

Don’t waste time fighting denials! By analyzing your data, you can identify the most common coding errors that lead to rejections. Regularly review these top 5-10 coding denials with your team (think monthly or bi-monthly meetings). This can often be traced back to confusion about the right codes or missing paperwork. Brainstorming these issues with your coders can educate them on proper practices and reduce denial headaches. Plus, building automated checks into your system will prevent those same mistakes from happening again, speeding up your cash flow.

7. Outsource your coding team

Many medical practices are turning to outsourcing their Revenue Cycle Management (RCM) to boost efficiency. With a lack of qualified coders available, outsourcing allows them to tap into a team of coding experts, ultimately improving the quality and speed of their entire revenue cycle.

Ending Notes

In addition to the tips mentioned, here’s how to get even more out of your coding team

• Ensure a balanced workload: Make sure your team has a manageable amount of work by adjusting the team size as needed. This helps them stay motivated and productive.

• Set achievable goals: Set realistic goals for your coding team to boost morale and keep them engaged.

Improve coding quality through a strategic review: To identify areas for improvement in coding accuracy, take a deep dive into your team’s structure, processes, and the systems they use. Following best practices in coding is essential for overall success.