Improving Medical Coding Quality

Even though medical coding plays a crucial part in revenue cycle management, it is the most neglected process of medical billing. As per the study report, documentation and medical coding are considered to be the weakest processes of the revenue cycle in 2019. Accurate medical coding will ensure the claims will get out the door quickly and reimbursements will come back quickly. One of the main challenges of medical coding originates from the lack of medical coding specialists. The second challenge is insufficient communication between providers and coders. Due to the COVID-19 pandemic, many coders have to work remotely hence widening this communication gap between provider and coder. For improving medical coding quality, we discussed few possible solutions i.e., frequently performing quality audits, using technology, and opening communication channels.  

Performing Quality Audits

Frequently performing coding quality audits is an essential element for improving medical coding quality. As per a study report conducted by Change Healthcare, over $262 billion in claims are initially denied every year largely due to insufficient clinical information. The same study also found that $28 billion in the denied funds were directly linked to a lack of clinical documentation. Monthly internal coding audits will prevent such ‘soft’ denials that require additional information for reimbursement. Performing quality audits will ensure that all coders are following payer-specific coding guidelines.

Frequent coding audits can identify areas that are leading to revenue leakage whether because of bad habits, workflow issues, or even lack of training. Coding audits will highlight any differences between your practice’s billed data and the national average. This difference may be caused due to potentially fraudulent or non-compliant coding and billing practices. Coding audits will also give your practice an outsider’s perspective to your medical coding quality. For coding audits to be effective, they should be carried out regularly, the data should be stored in the proper format for comparing. 

Use Technology

Computer-assisted coding solutions can help you to improve the quality and accuracy of medical coding. Computer-assisted coding (CAC) solutions are software products that can analyze healthcare documents to identify the appropriate medical codes for clinical documentation. With computer-assisted coding software, there is no need to dig through coding books. This technology will automatically alert on CCI and LCD edits, and your coder will be presented with auto-suggested codes, which will in turn increase accuracy.

Opening Communication Channels

Constant communication between provider and coding team is important as it will ensure that all procedures are documented properly, it’s coded properly, and no procedure is missed considering it as a non-billable procedure. Providers should communicate audit findings and any changes in coding compliance with coders as soon as possible. It will help coders to modify workflows immediately to improve coding quality. Communication also ensures coders are on the same page with updates to coding compliance, especially when so many coding updates are released.

Every year new codes are added, few codes are deleted, and some codes are revised. In years 2020 and 2021 we witnessed many revisions to coding that includes changed telehealth guidelines, the addition of many new codes related to COVID-19 vaccine and administration, and changed coding guidelines for all payers. When such revisions happen, coders and providers should proactively work together to standardize coding processes. 

Have a Coding Team

For small practices, most providers prefer to handle medical coding all by themselves. But medical coding is not just choosing the correct procedural codes and billing them. Medical coding involves payer-specific documentation, accurately choosing procedural codes, choosing accurate modifiers as per clinical scenarios, appealing denials with the required information, and coding audits to check compliance to payer coding guidelines. As providers are busy in inpatient care, they don’t have sufficient time to keep track of coding updates and payer-specific guidelines. So, it’s better to let coding professionals handle medical coding for you. 

As providers move to value-based reimbursement, guaranteeing medical coding quality will be key not only for getting paid for services but capturing the quality of care delivered. If you need any assistance in improving medical coding quality for your practice, contact us at / 888-357-3226