Coding in its various forms has been around for over fifty years. It has grown to be synonymous with justifying a provider’s care decisions and the patient’s level of service for billing purposes. Regardless of the care setting, ICD-10-CM (outpatient and practice-related) and -PCS (inpatient), CPT, and HCPCS coding are extremely important when maximizing insurance reimbursement, as well as minimizing claim denials and outright rejections.
With its many levels and intricacies, coding can impact revenue reimbursement and, ultimately, the bottom-line. If your business operations model relies on an in-house coding team, you may be experiencing avoidable delays in payment and timeliness in collections due to denials. To improve your coding program’s results going forward, consider the benefits of engaging a third-party medical coding partner.
Today’s Coding Challenges
Staying abreast of the challenges and complexities related to coding can be overwhelming for cardiology business office personnel, but it is one that can have long-term consequences. Not only do governmental and commercial insurance payers track code usage by provider, but should a problem be identified there can be serious legal and financial ramifications if miscoding continues unabated. Consider some of these issues:
- Does the Code Match the Actual Service — Were the right codes selected for the services provided. While this may seem implausible, in 2017, the average coding accuracy rate for inpatient services was only 61%.
- Appropriate Modifiers — Are appropriate modifiers for CPT and HCPCS codes used whenever necessary, i.e., new telehealth guidelines require modifier -95 to denote a remote location.
- Documentation — Every patient encounter should be documented to the fullest to not only assist in coding, but also prior authorization requests, insurance requests for information, denials management, and possible audits.
- Unbundled Charges — Every procedure or test must only be charged separately when not part of a designated diagnosis bundle.
- Level of Specificity — Care must be used to code to the highest level of specificity (maximum number of digits allowed) and not under-coded by complexity.
- Correct Order — Codes must be used in the order used, with the first code being the specific reason the care was delivered.
- Upcoding or Downcoding — coding should be for the exact level of service performed; purposely up or down coding can have serious consequences.
Why are Many Healthcare Leaders Vetting 3rd Party Coding Partners?
Cardiology practices move at a fast pace with appointed patient care mixed in with emergencies and unforeseen issues. Those employees tasked with the critical functions that make up the business operations rarely have time to complete their daily activities while chasing down provider documentation and charge slips. The ability to perform audits and quality control is almost non-existent, let alone keep up with the latest coding updates and regulatory changes.
By engaging a 3rd party coding partner, you can expect:
- Increased reimbursement using a thorough knowledge of primary and specialty coding, as well as inpatient experience,
- A vast, comprehensive understanding of the governmental and commercial insurance market,
- Data analytics and process improvements available 24/7, so that you know where your organization stands financially,
- Ongoing support and training for providers and staff, and
- Robust compliance and quality improvement program.
With improved coding execution, your organization would experience an increase in reimbursement that directly impacts the bottom line. Consider a partner such as Enhanced
Revenue Solutions by Infinx, that offers a high functioning and well-trained coding program capable of capturing the maximum reimbursement for your services.
Contact us to find out more today and consider our Health Check and coding assessment.