The medical sector has been undergoing a series of interminable changes over the last few years. In consequence, healthcare revenue cycle management (RCM) market is set to witness a marked growth because of the rising need for timely bill reimbursements and insurance claims. Increased complexity in the medical coding process has led to the necessity of RCM solutions that help reduce billing errors.
Almost three-quarters of struggling hospitals are re-prioritizing revenue cycle management over a number of other initiatives. A recent Black Book Market Research survey uncovered that hospitals leaders are pushing revenue cycle management to the top of their priority lists in this last quarter of 2017. The Black Book Research indicated that 74 percent of struggling hospitals are putting population health, analytics, physician practice acquisitions and recruitment, and patient engagement on the back burner to reprioritize revenue cycle management through Q4 2017.
A recent nationwide ICD-10 coding accuracy and productivity contest by Central Learning demonstrates the fact that the medical coding industry still needs to greatly improve in order to achieve a respectable and acceptable ICD-10 and CPT coding accuracy level. Although there was a slight improvement in inpatient and emergency department accuracy, the ambulatory surgery accuracy score decreased. The average inpatient coder accuracy was 61 percent and the average outpatient coder accuracy was 41 percent.
The Advisory Board Company in a press release earlier this year announced that the average 350-bed hospital has an overlooked opportunity of up to $22 million in revenue capture. Improving revenue cycle performance to decrease missed revenue opportunity means responding to four market forces.
A recent Black Book Market Research survey indicated that the outsourced coding and Health Information Management market is expected to double in 2018. Within this survey, Aviacode was once again ranked among the top vendors in outsourced coding.
If you are considering having a serious career in medical coding, the first thing you need to do to gain credibility is to get certified. There are several different types of certifications for medical coders so make sure you know which one would be best for you. The certifications are split into two different levels: entry- level certifications and advanced certifications. Here are some of the most popular certifications:
Certified Coding Associate (CCA)
This is offered through AHIMA and is one of the most basic certifications that they offer. The program is designed to give medical coders a general understanding of coding principles. It will create coding competency in both hospitals and physician practices.
- High School Diploma
- 6 months of medical coding experience
- Completion of an AHIMA approved coding program
These days, it’s easy to feel stretched for time with all of the things going on in healthcare. That’s why it’s extremely important that healthcare professionals are helping manage your practice’s time in the best way possible. Time management will affect the number of patients you see, how many medical claims you send out, and the overall effectiveness of your practice. Here are a few tips to help your practice manage its time properly.
- Set Goals for Your Practice
Make sure your practice has short and long term goals put in place. If you don’t know what you want for the future of your practice it will be difficult to be successful. Each goal you set should be a SMART goal: Specific, Measurable, Attainable, Relevant and Time Bound. Make sure the goals you set are written down, and reviewed frequently. Help maintain accountability by letting your staff know about the goals for the practice. Perhaps even give incentives to your staff if certain long-term goals are reached.
- Stay on Track with Patient Appointments
Your practice will experience revenue leakage starting the moment a patient schedules an appointment with you. Some of these leaks typically start out small but overtime they will make large dents within your practice. Below are some tips to help improve your rev cycle management system and prevent those leaks.
- Patient Information: Acquiring accurate patient information will help reduce claim rejections due to ineligibility, patient not found, or service not authorized. Implement a checklist at your practices registration office to help insure accuracy. The staff member registering a patient should verify the patient’s information, take a photocopy of the patient’s insurance card, and review the patient’s insurance (optimally, this would be done before the physician sees the patient in order to avoid performing services that are not covered).
E/M coding has become the most frequently billed physician service, and auditors are taking notice of its popularity. There is a fine line to walk when it comes to Medical coding. Frequent E/M coding errors occur when medical practices are either upcoding or undercoding. Upcoding increases the risk of audits. Coding too conservatively doesn’t protect your practice from audits, and it severely decreases your level of reimbursement. Here are some tips to help you stay on the straight and narrow:
- Sending out Claims Under the Wrong Provider: Popular medical coding errors occur when nurse practitioners and physician assistants report services improperly. Often times NP’s or PA’s will send out claims under the physician’s name and National Provider Identifier, but if the patient was treated solely by the NP or PA, the claim should be billed under the mid-level practitioner’s name and NPI.
Who Participates in Medical Coding?
Coding is a team effort, with the certified medical coder leading the way.
Medical coding starts with a patient making an appointment to see their physician. The receptionist makes the appointment – without the appointment the coding process would fail to start.
Physician or Healthcare Provider
Next, is the physician, or healthcare provider. They diagnose the patient based on their symptoms (complaints), and in some cases blood tests, x-rays, or any number of other test(s).
Certified Medical Coder
Then the medical record makes its way to the certified medical coder. The coder translates the written clinical documents into codes. This coding process allows the physician or healthcare provider to receive payment for the services they have provided to the patient.