Coding Compliance & Reimbursement Enhancement Strategies – An Analysis

Acting in accordance with the established guidelines and specifications is vital for every business. In terms of a healthcare facility, various aspects will be taken into account including medical coding and billing processes. Coding Compliance & Reimbursement Enhancement Strategies. As a matter of fact, it is necessary for Healthcare facilities to adhere to the various regulations which are designed to avoid the scope for fraud and abuse.

If you are a medical coding professional, then you must acquaint yourself with the various compliance rules and regulations. In addition, you need to comply with them for the benefit of your career and the improvement of healthcare quality in general.

As you witness the transition of the healthcare landscape from a fee-for-service model to value-based care, there is a burgeoning challenge of staying financially healthy. Various factors have influenced a practice’s revenue.

Healthcare organizations need to work jointly with their medical billing and coding companies. This is mainly to create winning strategies that can accelerate reimbursement and revenues in an effective manner.

Here’s a deep analysis of some of the proven medical billing and coding strategies that optimize the revenue cycle performance. In addition, it can also drive up an organization’s financial health manifold.

1. Coding Compliance Medical Coding Compliance is a note-worthy part of healthcare Revenue Cycle Management. It ensures critical patient data security and privacy while defending against audits and revenue leaks.

2. Use Modifiers Correctly You can use Modifiers in fusion with Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS). They can be used to notify insurers of possible special circumstances. For instance, errors in modifiers can hold the ripple effect of causing billing errors and claim denials. These can tentatively disrupt the overall healthcare revenue cycle.

Notably, Medical billing service companies are apportioned with well-trained and certified coders. They help in preventing coding errors by utilizing the right modifiers.

1. Telemedicine Services & its Reporting The unexpected boost in the adoption of ‘telemedicine solutions’ owing to the global pandemic has enhanced patient access. Furthermore, it has also jacked up patient satisfaction scores to a remarkable extent.

Nevertheless, reimbursements could pose a challenge for remote healthcare services, and healthcare organizations should compulsorily stay tuned to the latest CMS updates and reassess strategies to improve telemedicine reimbursements.

1. Avoid Chronic Care Management (CCM) Denials Claims which are submitted within 30 days of discharge for the same patients are most likely to be turned down by payers. This is one of the prime reasons hospitals and practices assimilate digital patient engagement solutions. It phenomenally reduces readmissions and magnifies health outcomes.

2. Perfect Code Transitional Care Management (TCM) TCM is yet another area that comprises higher denial rates. In order to put an end to TCM denials, care coordinators should reach out to the patients discharged. They should have an interactive conversation with them (phone, in-person) within two days to get precise information.

Proper documentation of Admission Discharge Transfer (ADT) feeds, discharge summaries and flawless integration of data into the EHR management are also declarative factors. This will spur the admin staff to engage with patients in an outpatient setting quickly.

The more detailed the documentation, the lower will be the denial rates. So, ensure that you harness the payer with accurate and also meticulous documentation, in particular.

1. Insurance Verification Eligibility verification and pre-authorization are some of the checklists you need to double-check to evaluate the insurance coverage and patient responsibilities preceding the appointment.

Failure to verify them could lead to unnecessary annoyance in terms of delayed or denied claims, diminished patient satisfaction as well as non-payment.

1. Keep Track of Key Metrics Healthcare revenue cycle management companies can always help with timely and detailed reports and analyses. However, it is the responsibility of the clinicians to decode and comprehend these reports to come up with the right business decisions. In addition, physicians need to keep track of these critical insights by and large.

People who are in medical coding jobs and the medical billing profession must strictly adhere to the rules along with the regulations concerning the confidentiality of healthcare information. It is because they deal with the sensitive and also some private information of scores of patients.

There are varied areas of compliance for healthcare professionals. Even, medical coders have the arduous task of keeping up with the ever-changing medical codes, laws, and regulations.

Regardless of the challenges faced, every healthcare facility has to concur with the various rules and regulations. This aids them to avoid penalties or negative effects on reimbursements and the facility’s reputation. On the other hand, non-compliance with coding and billing regulations can severely impact a healthcare facility’s reimbursements, collections, and above all, overall financial performance.

Medical coders register a patient’s journey through the healthcare system with the help of various codes. For correct billing and reimbursements, accurate medical coding is integral. Still, many errors in claims payments occur due to insubstantial documentation and coding.

Medical coders authenticate a healthcare facility’s compliance by making use of standardized codes and coding guidelines thereby streamlining the revenue cycle management.

Medical coding professionals really play an illustrative role in both the revenue cycle and patient care quality. Hence, healthcare facilities and medical coding companies must make sure that their medical coders are aware of the various compliance requirements. They should also check whether they adhere to them always. If required, they must be provided regular and rigorous training to keep abreast with the newest rules and regulations related to their profession.

Conclusion: Technology has the zeal to optimize coding compliance. But the systems are also key in addressing the top challenge of coding and compliance.

Coders and compliance staff have traditionally had an aggressive relationship with physicians and other providers. Providers do not wish to be told how to deliver medicine to maximize reimbursement. As a matter of fact, additional documentation and coding requirements can lead to burnout for providers.