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presentation

Proactive Strategies to Optimize Medical Coding and Billing in 2017

February 22, 2017



Proactive Strategies to Optimize Medical Coding and Billing in 2017

As per the latest report, ICD-10-PCS codes for 2017 are expected to be around 75,625 which is an increase of 3,651 new codes and around 487 revised code descriptions. Approximately 5,400 codes are being added, deleted or modified. The additions are good news for hospital coders because there will be better options to represent procedures. Similarly, for physicians, the changes are significant as 2017 ICD-10-CM will include 1,943 new codes, 305 deleted codes, and 422 revised codes. There have been hundreds of revisions and improvements for example, around 299 to diabetes mellitus codes.

As per CMS, the code(s) choice that has been eligible for reimbursement in 2016 will no longer be available in 2017. Probably the most important step a coder must take is not to use unspecified codes, unless and until there is no other option. Apart from avoiding unspecified codes, be sure to review local and national coverage determinations for coding changes. A practice/organization's financial health and credibility is directly linked to coding compliance. Therefore, for success in revenue cycle management, it's important to keep the right systems, processes, trained resources and coding resources up-to-date.

Following are some of the proactive strategies on optimizing your medical billing and coding for the year:

  • Ensure proper documentation for coding accuracy: With the move from volume to value, right documentation has become very critical. The increased specificity of ICD-10 and various rules for value based models call for detailed and accurate documentation. Payers will only reimburse claims only if they are supported by medical necessity and right documentation. Medical practitioners need to master the techniques of using electronic health records so as to capture clinical information in a comprehensive way.
  • Understanding MACRA and focusing on value-based care: The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), bases reimbursement from fee-for-service to quality and value of services. So rather than volume and profitability of services, it's all about the patient-care and what a patient needs. This shift will have a great impact on documentation, coding and reimbursement as per the specialty. Medical schools too are restructuring their courses in a way to give more importance to value-based care. So to increase a practice's income, all it requires is evaluating all the measures for data reporting, and selecting and reporting metrics in high performance areas.
  • Enhance your revenue cycle management: As a practice, if you prefer working on medical billing and coding in-house, ensure that your staff updates their knowledge and skills regularly as per the changing coding, compliance rules and regulations. If you rely on medical billing and coding companies, it's good to work with them as a team to enhance your overall revenue cycle management. In fact, in the current dynamic scenario, outsourcing is proving to be a practical option to drive improvements in coding and reimbursement process.
  • Keep a track on denial rate: Out of the key five metrics of revenue Cycle Management –
    • Days in Accounts Receivable (AR)
    • Days in AR (>120)
    • Adjusted Collection Rate
    • Denial Rate and
    • Average Reimbursement Rate
    The percentage of claims denied by the payer or the denial rate is a key metric that shows the effectiveness of your coding and billing practice. But with more aggressive medical value-based models getting in place such as end of grace period on unspecified ICD-10 codes by the Centers for Medicare and Medicaid Services (CMS) and regular updating of ICD-10 codes to increase specificity, denial rates are bound to escalate.
  • Delegate important function: It's important to delegate some of the important functions such as patient education and data collection to experts or well trained assistants will help you in saving time and managing your resources effectively. For example, assign patient benefit verification to an insurance verification specialist.
  • Explore strategies to collect bad debt: Though the focus shifts on providing value-based care and increases responsibility of payment on patients, physicians should explore various strategies to collect bad debt. Implement strategies such as:
    • Convenient payment options and incentives, especially for patients who have difficulty paying
    • Be compassionate while answering any questions related to billing.
    • Implement strategies to target collection efforts
    • Opt for professional help to deal with uncollected balances, if need be.

In the rapidly evolving healthcare environment, following a proactive team-based approach will not only monitor the health of your practice but will also ensure you deliver value-based care to your patients with minimum bad debt.

 

Category : Revenue Cycle Management