Medical coding and compliance programs are very different today from what they were years ago. In the past, these programs had relied upon manual processes and time-intensive reviews of code selection. Before the digital age, these processes had been very prone to error, and it was easy for revenues to be lost and for errors to make it into insurance claims. While these kinds of mistakes cannot be completely avoided, modern technology minimizes the chances of these errors happening. Advanced technology automates repetitive tasks, which reduces costs, mitigates risks, and improves productivity. Healthcare providers who take advantage of new technologies can better succeed as the world changes and consistently continue generating more revenue than their competitors.
The recent increase in audits and scrutiny of healthcare providers has meant that organizations need to focus more than ever on integrating new technology into their processes. This is also important because record keeping, as well as medical coding, is increasingly becoming more complicated. While new scientific and business advancements make this level of complexity necessary, productivity and efficiency don’t have to suffer because as a result. Healthcare providers can review common coding and compliance processes in order to find inefficiencies and make sure that their technology is up-to-date. The most important processes to analyze are: code selection, code review, and audits, as well as education and compliance. Keeping these processes streamlined ensures that a healthcare provider can function at an optimal level at all times.
Code selection is important because using the proper identifiers for medical procedures is essential for earning revenue. Electronic medical record systems allow providers to select specific diagnosis codes and billing codes in order to streamline their processes. Since standard codes can change, however, it is possible for these electronic medical record systems to contain incorrect information if they are out of date. Allowing providers to select their own codes raises the further risk of human error. These individual systems may also be missing specific rules or requirements if they don’t have the capacity to update themselves automatically. Some healthcare providers can find out-of-the-box electronic medical record systems to be enough for their needs, but others may require integration with a third-party provider in order to obtain specific codes or gain particular capabilities. Certified coders may help to reduce human error, but the best way to avoid consistent errors is to remain informed about any and all changes in coding standards. The ICD-9 coding system is significantly different from the ICD-10 coding system, and CPT codes have changed dramatically over time. New software solutions take these changes into account, while old systems may not. Relying on old technology in code selection could result in significant coding errors, which could, at best, lose revenue for a provider or, at worst, cause problems for patients with regard to their medical care.
After the initial selection of diagnosis and billing codes, a best practice is to review these codes before submitting them to an electronic medical record system or to an insurance company. The majority of errors in insurance company submissions come from simple coding errors which can be caught before submission. New tools are available to help healthcare providers find coding errors before they can cause problems with claims. Claim scrubbers use a rule-based engine to identify coding issues. Some of them can integrate with an existing system, while others are separate, and some can interpret charts or use natural language processing. These review systems can also benefit from new technology as language processing, artificial intelligence, and new logics make systems smarter. Healthcare providers can create increasingly complex rules to flag codes that may be incorrect. Since claim denials can take far more time than simple reviews, the occasional false positive is worth the amount of time saved. The more time is saved, the more productive a healthcare provider can be and the more revenue it can earn.
Properly training coding staff is vital to ensuring that coding is correctly done. There are many different facets to this process, including: audits, education, and compliance. Compliance is the overall goal in order to best ensure that coders follow the proper coding rules. As coding standards and technologies change, medical coders need feedback about how they are doing and how to best perform their jobs. Therefore, as technology changes, medical coders must be trained with respect to those new technologies. Healthcare providers should also consistently audit these staff members to evaluate their performance and identify elements that could be improved. Distributing educational material on a regular basis can also be useful, and keeping communication lines open can provide coders with the ability to ask for help when they need it.
Reviewing coding and compliance technology is useful for any healthcare provider. Since these technologies impact everything else the provider does, it may also be prudent for a provider to do a comprehensive review of all internal processes in order to maximize efficiency. Coding and compliance issues may expose other internal problems, all of which should be addressed explicitly in an effort to make the provider as productive and profitable as possible. eReceivables has extensive experience in analyzing workflows and processes, especially with regard to coding, compliance, and potential technology upgrades. The best way to ensure that systems remain up-to-date is to have an experienced partner to guide a provider through changes in both industry and technology. Contact eReceivables today for more information.