People in medical coding jobs and the medical billing profession must strictly follow the rules regarding coding and billing processes along with the regulations pertaining to the confidentiality of healthcare information as they deal with the sensitive and private information of scores of patients. There are a lot of areas of compliance for healthcare professionals, right from the point of a patient’s visit to the front office to the point of claiming reimbursements or collecting from the patient. Further, medical coders have the challenging task of keeping up with the ever-changing medical codes, laws and regulations. However, regardless of the challenges faced, every healthcare facility has to comply with the various rules and regulations to avoid penalties or negative effects on reimbursements and the facility’s reputation. Non-compliance with coding and billing regulations can severely impact a healthcare facility’s reimbursements, collections, and overall financial performance.

Medical coders are professionals who record a patient’s journey through the healthcare system with the help of various codes such as ICD, CPT and HCPCS codes. For correct billing and reimbursements, accurate medical coding is imperative, however, many errors in claims payments occur due to insufficient or inaccurate documentation and coding. This emphasizes the role of people in medical coding jobs who translate a patient’s encounter from the time of initial scheduling to the time of final payments. Medical coders ensure a healthcare facility’s compliance by using standardized codes and coding guidelines thereby streamlining the revenue cycle, reducing claim disputes and adhering to governmental regulations. Here are some of the top coding strategies suggested by top medical coding companies that can help healthcare facilities to improve their reimbursements and collections.

• Healthcare documentation: Medical coders get the patient encounter information from the healthcare documentation reports and if these reports are incomplete or inaccurate, coders can’t code accurately. To help medical coders do their job accurately and be compliant with the coding regulations, healthcare facilities must invest in quality healthcare documentation processes and healthcare documentation specialists who provide accurate reports that form the basis for the coding process.
• Technology use: Appropriate technology must be used and technological updates must be implemented as and when necessary. This is a must to streamline and optimize the claims management process and reimbursements. Optimum utilization of technology helps medical billers to understand the accounts that are impacting the facility and prioritize such accounts to collect the maximum amounts promptly.
• Education: Provider and staff education also plays a key role in the appropriate coding and billing compliance. Healthcare facilities must educate their physicians and other healthcare providers on the need to document all patient encounter procedures appropriately thereby improving collaboration between the providers and the coders.

Medical coding professionals play a critical role in both the revenue cycle and the quality of patient care. Hence, healthcare facilities and medical coding companies must ensure that their medical coders are aware of the various compliance requirements and adhere to them always. If required, they must be provided regular training to keep themselves updated with the latest rules and regulations related to their profession.

• It’s emotionally rewarding: Few jobs can boast of helping others directly. It is no way exaggeration if we say that doctors top this list of people who can help in times of need. But, all of us cannot become doctors; however, many healthcare-allied jobs can give you the satisfaction of helping others in protecting their health. Medical coding jobs are one of these that can give a sense of satisfaction in maintaining accurate records of patient’s healthcare data while helping the healthcare facilities to cut costs by reducing medical mistakes. Medical coders must be highly alert while assigning codes to various procedures because there’s always a risk of incorrect codes leading to wrong treatment and fatality. Hence, when coding is done accurately and helps save the valuable lives of patients, medical coders gain the satisfaction of giving patients a healthy, quality life.
• It’s fast-paced: Medical coding industry is one where changes occur regularly due to the introduction of new technologies and new regulations. This helps in improving the way patients’ medical records are stored, used and shared; further, it paves the path for ongoing learning and adaptability for professionals in medical coding jobs.
• It doesn’t need medical school education: To get into the medical coding career, you need not attend medical school for years. You can step into this career with a few months of formal training which costs significantly less compared to regular medical school education. This aspect makes medical coding a suitable career choice for people who are just out of college and those who want to make a midlife career change. Usually, a medical coding course can be completed within a year with which you can land good jobs. To improve your knowledge and go higher on the career ladder, you may clear exams conducted by the American Health Information Management Association (AHIMA) or the American Academy of Professional Coders (AAPC) and gain coding certifications.
• It gives work flexibility: Medical coders have the flexibility of working at hospitals, clinics, nursing homes, medical laboratories, administrative support centers and even medical coding companies. With such a wide range of organizations that need medical coding professionals, you will have access to a dynamic job market with a plethora of opportunities. Further, medical coding jobs are flexible per work timings as well. Several hospitals and medical coding companies offer jobs in varying shifts during the day and night; so you can opt for medical coding even if you are a night person.
• It’s financially rewarding: Last but not the least; you can rest assured of a good salary in a medical coding career. Depending on your experience, skills to code for specialities and coding certifications, you will be eligible for the best salary in the industry.

Have you just finished college? Are you thinking of a change in your career? Go for medical coding, the best administrative occupation in the healthcare industry that gives you the satisfaction of working for the health of people.

To understand better, social determinants of health can be categorized as:

• Economic stability: The economic status of people determines their capability to afford healthy food, healthcare, and housing. Economic stability comes with steady employment and those with economic stability are likely to be healthy. However, the challenge is with people with disabilities or serious health conditions who are limitedly capable of working affecting their quality of life and capability to spend for their healthcare.
• Education accessibility: People with access to good education and higher levels of education are likely to be healthier as compared to those with lower levels of education. A person’s financial status, disabilities and experience of social discrimination can affect his/her education thereby impacting the health in the long run due to low-paying jobs and other mental issues.
• Healthcare access and quality: People who are financially strong or have insurance coverage have access to better quality healthcare. Further, sometimes, access to healthcare depends on the distance of a patient’s place from the healthcare provider’s.
• Neighborhood and environment: The environment in which people live and grow up has a big impact on their health. Access to safe air and water and harmonious neighborhoods can improve health and quality of life.
• Social and community context: The kind of relationships and interactions people have with their family, friends, coworkers and community members affects their health.

To provide good and quality healthcare, it is essential to understand these socio-economic factors of patients’ lives that are beyond the healthcare system and with the access and use of social determinants of health data. Medical coding professionals must know this information because they have to use Z codes, a special group of codes in ICD-10-CM codes, to report the factors that influence health status and contact with health services.

What are Z codes?

Professionals working in medical coding companies should be well-versed with Z codes which are diagnosis codes applied for situations where the patients are not diagnosed with a known disorder. These codes (Z00-Z99) represent the reasons for encounters and must be accompanied by a corresponding procedure code wherever a procedure is performed. Medical coders and other professionals in medical coding such as team managers must follow the ICD-10-CM coding guidelines and accordingly assign the corresponding codes to various encounters and review the codes for quality and consistency. Here are some Z codes that need to be well-understood by the medical coders.

• Z55 relates to problems associated with education and literacy
• Z56 relates to problems associated with employment and unemployment
• Z57 relates to occupational exposure risk factors
• Z59 relates to problems associated with housing and economic circumstances
• Z60 is about problems related to the social environment
• Z62 is about upbringing issues
• Z63 is related to problems associated with family circumstances and primary group
• Z64 and Z65 are about problems associated with psychosocial circumstances

Social determinants of health play a critical role in healthcare delivery and hence, it is essential that the medical coding fraternity understands this role and accordingly assigns accurate SDOH Z codes on the basis of self-reported data and or information documented in an individual’s health records.

What is HIPAA?

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a US federal law that set some standards to protect the personal and medical information of patients. The act comprises five titles or sections. In order to be eligible to provide medical coding services to US healthcare facilities, it is essential that medical coding companies know and are compliant with various HIPAA provisions in these titles.

• Title I: This section is related to the provisions to protect coverage of health insurance for people who have changed or lost their jobs. Also, this section provides safety to people with pre-existing diseases or conditions by preventing group health plans from refusing to cover such people.
• Title II: This section provides for the safety of patients’ data by directing the United States Department of Health and Human Services (HHS) to standardize electronic healthcare transaction processes. This section mandates the organizations to incorporate safe electronic access to the patient’s health information by complying with privacy regulations set by the HHS.
• Title III: This section relates to the tax-related provisions and general medical care guidelines.
• Title IV: This is related to reforms in health insurance.
• Title V: This section is related to provisions regarding company-owned insurance and treatment of individuals who lost citizenship owing to income tax reasons.

Since, the means of collection, storage and access of patient information have moved from paper-based records to electronic formats and files, the risk of accessing, using and disclosing sensitive personal health data has increased considerably. To address this risk, the HHS has brought in privacy standards that provide for basic protection standards across the country. Simultaneously, to improve the healthcare system’s efficiency and effectiveness, administrative simplification provisions were included to bring in national standards for electronic healthcare transactions. Further, to protect the individually identifiable health information while using electronic technology for healthcare, certain provisions were incorporated mandating the adoption of federal privacy protections.

The HIPAA Privacy Rule

The Standards for Privacy of Individually Identifiable Health Information (The HIPAA Privacy Rule) is important for medical coding professionals as it –

• Provides the national standards for protecting the privacy of health data.
• Provides regulations for certain entities (covered entities) to use and disclose protected health information (PHI).
• Offers more control to patients over their health information.
• Sets limits for the use and release of health records.
• Sets guidelines and standards that healthcare facilities must achieve to protect health information privacy.
• Holds violators responsible for violating patients’ privacy rights.
• Enables patients to find out and make informed choices as to how their information may be used or disclosed.
• Enables patients to obtain a copy of their health records and request corrections.

Since healthcare providers who transmit health information in electronic form in connection with certain transactions fall under the covered entities, for the purpose of compliance with HIPAA, it’s necessary that they partner with HIPAA-compliant medical coding companies for good results and avoid penalties on violation of norms. So, it’s critical that healthcare facilities choose the best medical coding companies that are compliant with HIPAA and its privacy rule.

As the world is reeling under the pandemic crisis, healthcare providers are overwhelmed with burgeoning office work that is required to claim their timely medical reimbursements, collect patient payments, and comply with government regulations. A significant part of the office work is carried out by the medical coding department that assigns accurate codes to the procedures performed during the treatment provided to the patient. With the increasing burden on the medical coders due to the rising demand for healthcare services during this pandemic crisis, it’s getting imperative for healthcare facilities to look for outsourcing options to mitigate the risk of overload on the in-house medical coders and the resultant errors leading to claim denials and rejections. The medical coding services industry is a booming industry and India is one of the top countries to which medical coding jobs are outsourced by several healthcare facilities in the US.

If you are thinking of a career in the medical coding field, you are in the right direction and here are some reasons you should take up medical coding.

• In-demand job: Due to the increased number of cases in healthcare facilities, there is a huge demand for medical coding professionals whereas the supply of certified medical coders is comparatively much lesser. The demand for skilled and certified medical coders will only increase in the coming times to ease the functioning of the revenue cycle and improve the bottom line of healthcare facilities.
• Lucrative job: Due to the rising demand for skilled coders, medical coding companies are willing to pay good salaries and hence, the medical coding profession can be a lucrative option in healthcare-allied professions.
• In-demand skill: Medical coding is not a mere data entry job wherein you key in certain codes for the description given. It is a profession that requires great analytical and decision-making skills along with good knowledge of medical terminology. If you can understand human anatomy and medical terminology and possess good analytical skills, medical coding can be a great option for you as medical coders need to interpret the data given and analyze it correctly to assign accurate codes for the procedures.
• Quick start of career: Unlike many other professions, training for medical coding jobs can be completed in less than a year depending on your skills and kick-start your career successfully. Further, you can enhance your skills while working by completing various specialist coding certifications.

Success in any industry depends on both technical and soft skills; you can be a successful medical coder if you possess good skills in the English language and medical terminology along with analytical skills, and can think innovatively when required. Other significant aspects that can help you become a successful medical coder are perseverance and willingness to learn continuously to update your knowledge from time to time so as to establish and maintain domain expertise. Choose the best medical coding companies to start your career in medical coding which is one of the most sought-after professions in these times.

Apart from these, another major change that came along was the increased use of telehealth services. Although telehealth services are not new, they gained momentum during the pandemic phase. Remote working was common among many other professions and industries, but healthcare service was majorly working from the office. With the pandemic crisis, people preferred consulting doctors remotely wherever possible to avoid contracting the virus. Physicians and healthcare facilities also promoted telehealth services to avoid crowds at hospitals and clinics. Amidst all these changes, allied healthcare professionals in the fields of medical coding and revenue cycle management had to face challenges of confusion over COVID-19 coding and claim requirements. These issues impacted several healthcare facilities’ revenue cycle operations in the last year. It was identified by the industry experts that the average hospital claim denial rate increased during the pandemic crisis period wherein about 11% of claims submitted were denied. The studies reflected that the major risk areas that are leading to a dip in clinical revenues are clinical documentation and medical coding.

This is because; there are high chances of claims getting processed quickly when professionals in medical coding jobs assign accurate codes to the procedures. However, when there are issues with coding accuracy, missed deadlines, wrong submissions or training of the medical coding professionals; it often leads to denied claims resulting in delayed revenue or loss of revenue for healthcare facilities. Here are some amazing tips to improve your coding quality for a healthy revenue cycle.

• Coding workflows: With the huge volume of charts to code, it gets overwhelming to work on denied claims as it is a cumbersome and time-consuming process with tremendous research and rework involved that has to be completed within a deadline. It is hence, necessary to educate the professionals in medical coding companies and jobs about the updated rules and regulations to prevent errors repetitively. It is also advised to revisit the coding workflow and assess if the coding team is adequately staffed to tackle the workload, define task lists and priorities and decide the responsible people for various parts of the process such as new claims, denials, and edits.
• Best partner: Partnering with the best talent is the first step to achieving coding accuracies and you can improve your medical coding process by hiring high-quality coders whether in-house or outsourcing to a medical coding company.
• Compliance audit: Accuracy and completeness in coding results in a high-performing revenue cycle and ensures that healthcare facilities are in compliance with the government’s healthcare regulations. To ensure the revenues are not lost due to insufficient clinical information or clinical documentation and the medical coding practices are matching the standards set, coding compliance audits must be implemented. These audits verify a specific number of charts per qualified healthcare professional and check the accuracy of services and codes mentioned. Compliance audits can help identify areas of improvement to check revenue leakage by identifying areas of trouble and opportunities for training, thereby expediting claim reimbursements.

Timely reimbursements are imperative to improve the revenue cycle of healthcare facilities which is possible with appropriate and accurate documentation and coding. Outsourcing these processes to the best medical coding company such as Avontix, can help you immensely in streamlining your coding process for better revenues.

Medical coding is a fabulous career and it involves assigning codes to all the services and procedures performed by a healthcare provider on a patient. The medical codes aid in health-related studies and research. However, the main purpose of giving codes to the services offered is to standardize the processes and procedures across healthcare facilities to help the insurance payers understand the various aspects of a patient encounter to the highest specificity and determine if the services provided are eligible for reimbursements. People in medical coding services translate the physicians’ documentation into standardized alphanumeric codes to help medical billers prepare accurate bills that give the insurance payers an accurate analysis of –

• Patients’ diagnoses
• Medical necessity for the services, treatments and supplies provided to the patients
• Treatments, services, supplies provided and equipment used for the patient
• Any other medical condition or circumstance that affected the services provided.

To provide such detailed information in simple codes, it becomes essential that there are codes for every kind of ailment, disease, suffering, and symptom, the place in the human body which is impacted, the kind of equipment used and services provided. This is the reason; there are thousands of medical codes that need to be understood by the medical coders. Those who are in medical coding jobs understand the intricacies of assigning accurate codes and do their job perfectly with the help of the various coding manuals. There are some common codes that almost all coders are used to because they are related to the most common ailments. But, there are some codes that many medical coders would also be not aware of because of their rare incidences or their uniqueness. Let us see some of the strange medical codes that the medical coders may encounter –

• Prolonged stay in a weightless environment, initial encounter: X52.XXXA is a billable code that describes the circumstance causing an injury related to prolonged stay in a weightless environment which is usually experienced by astronauts.
• Tidal wave due to landslide, initial encounter: This is a diagnosis code – X3743XA. This code doesn’t specify the injuries related to tidal waves caused by storms, earthquakes, and volcanic eruptions. It specifies a tidal wave due to a landslide.
• Explosion of bicycle tire: This billable code (W370XXA) is related to the initial encounter with an explosion of bicycle tire in the category title of explosion and rupture of pressurized tire, pipe or hose.
• Walked into wall: W2201XA is a billable code used to indicate a diagnosis that describes the circumstance causing an injury. W22 codes are related to striking against or struck by other objects and this particular code specifies walking into a wall.
• Assault by hot tap water: X981XXA is a code used to specify assault by hot tap water, an initial encounter which means assault by tap water that’s been heated or assault by people with water straight from the tap.
• Problems with in-laws: Could you ever imagine that there would be a code to specify problems with in-laws? Yes, there is indeed a code for this. Z63.1 is a code that deals with problems in the relationship with in-laws.
• Other contact with pig: Don’t mistake this code for a bite of a pig or getting struck by a pig. This code specifies other contacts than these. The code used is W55.49X.

These are some of the rare or strange medical codes that can be used by people in medical coding jobs when needed. It is not essential that each and every code is memorized by medical coders because there are thousands of codes in different code sets like ICD -10 code set, CPT code set and HCPCS code set. Whenever an unusual or strange encounter is reported, it is better to refer the code manuals and then assign the code to the highest level of specificity and accuracy.

Medical coding is a critical process in the healthcare field that uses medical code sets that keep changing periodically. Those in the medical coding jobs need to update themselves with all the changes that happen from time to time and ensure that they don’t even miss a single detail. This is an absolute necessity in the field of medical coding because it is the key to learn the coding nuances and assign accurate codes to the various healthcare services, procedures, diagnoses and equipment used. Only when accurate codes are assigned to the services provided a healthcare organization can get complete and appropriate reimbursements. Here given are some of the ICD-10-CM clinical coding challenges that the medical coders may have to encounter in the year 2020.

• Coding Clinic: One of the most common challenges for various people in the professions of health information management, coding, and clinical documentation improvement is to keep up with the AHA coding clinic on ICD-10-CM /PCS coding, and HCPCS. The American Hospital Association’s central office serves as the official medical coding clearinghouse and provides valuable guidance and insights into different ICD-10-CM/PCS scenarios and challenges. Every medical coder should have access to the coding clinic publication to read through the full content and keep up with the latest updates.
• Social Determinants of Health: According to the experts in medical coding jobs, social determinants of health (SDoH) ICD – 10 codes will continue to be an important series of codes. These codes help healthcare providers to identify people who may have a social determinant of health that builds a barrier to health and wellness.
• Medicare advantage: Insurance companies use hierarchical condition category (HCC) codes to assign patients a risk adjustment factor score. It is critical for people in medical coding jobs to stay updated with the latest annual update on the addition or deletion of codes from the Centers for Medicare & Medicaid Services (CMS) HCC model annually. An increasing number of patients are choosing Medicare Advantage / Risk Adjustment as their payment model increasing the need for medical coders to be more knowledgeable about the HCCs.
• Coding compliance: Medical coding companies should ensure that they have a strong and transparent coding compliance process in place to avoid legal hassles as the scrutiny around clinical documentation and coding has increased over time. To have a coding compliance process in place, it is necessary to implement two key components – auditing and education. Implementing regular auditing and education programs periodically is a challenging yet essential aspect to help minimize fraud, waste and abuse of healthcare funds and provide quality care to the needed people.

There would be multiple challenges in the medical coding field from time to time. But, facilities and medical coders need to identify the right resources and tools to address those challenges by being informed, educated and staying alert to the latest updates in the industry.

Medical coding is a specialized field and requires skills that need to be attained with training. Although some medical coding companies offer training and hire those who successfully complete the training, there are companies that hire only people with appropriate credentials from AAPC. But, one of the things observed in many candidates who wish to achieve coding credentials from AAPC is that they struggle a lot with the education and exams. The examinations conducted by AAPC are challenging not just for novices but even for those who have experience in medical coding jobs. Here are some tips that can help you to clear your AAPC credential exams.

• Get proper education: The AAPC coding credentials’ standard includes questions from CPT, ICD and HCPCS manuals. Hence, it is required that, to clear the examination, you need to study and understand all these manuals. If you are a newcomer to the industry, you would anyhow want to understand all the basics, so you would be studying all these manuals. However, if you are already into the field of coding, you may be under the false impression that you know so much about the industry and have experience in it and there is nothing new to learn. But, what you need to understand is that you could be having experience in a niche market of coding. So, the first step to clear a coding certification exam is to enroll in a course from a reputed institute that offers proper in-depth knowledge base needed. You will need a trainer or coach who understands where you stand, where you stumble and keeps you on track while clearing your doubts and answering your queries.
• Review your skills: To clear the coding certification exams, you will need to sit for a long duration of nearly six hours. Although the exam is conducted with two breaks in between, it is a rigorous exam that needs to be attended with a lot of mental strength and complete confidence. To sit and write an exam for such a long duration, you need to be really prepared and you should know what kind of questions would be asked and how you would answer those. Having your manuals in front of you is not sufficient to clear a coding exam. You need to know the key concepts that you are going to be tested on and be confident about answering them with authority. Approach your coach and ask the coding guidelines you ought to know to clear the exam. Don’t mark up your manuals in such a way that it hampers your ability to get to the highest specificity.
• Learn time management: However good you are at the subject, your efforts will not be fruitful if you don’t learn how to manage time. You should learn to practice for exams with timed exams that let you know your time management skills while answering the questions. You should take practice exams that give you hands-on experience of the actual coding credential examination.

Once you are done with the training part, what you need to excel in medical coding jobs is the coding certification from AAPC. Take the exam, prove yourself and join the best medical coding companies for a rewarding and satisfying career.

Medical coding professionals have a huge responsibility of transforming the diagnoses, procedures, services and equipment used by medical professionals into universally acceptable medical codes so that they are helpful for both the billing process and facilitate health-related studies. Medical coders have added responsibilities on them apart from this core responsibility due to the technology updates and the industry-related trends and updates. The people in medical coding jobs have to embrace these added duties so as to do the best of their job and shine in their career. Mentioned below are a few of the key factors that add to the responsibilities of the medical coding specialists.

• Outpatient coding – Physician coding, a part of medical coding jobs plays a vital rolethat needs expertise in both technology and coding knowledge. Many experienced coders are of the opinion that accurate physician code assignment is not that easy as people tend to think and requires a lot of expertise on the part of coders. To get both the inpatient and outpatient professional fee coding correct, it is required that medical coders are appropriately cross-trained by the medical coding companies so that claim denial in outpatient settings is reduced to a great extent.
• EHR transitions – With the adoption of electronic health records becoming mandatory for all healthcare providers, medical coders have another task for them. There will be many instances where coding professionals will have to work on claims edits during the conversion to EHR or after the EHR implementation. Instead of making the medical coders work randomly on EHR edit queues during the coding process, the medical coding companies can train a few coders as specialized edit professionals who are trained particularly in EHR system edits and work queues.
• Collaboration with CDI professionals – Good collaboration among medical coders and clinical documentation improvement (CDI) specialists is essential to avoid any kind of revenue cycle issues that pop up as a result of poor communication among them. There should be proper integration of the two teams involving these two professionals that helps in understanding clinical validation rules, best practices, documentation, coding and payer rules.

With changing times and enhanced technological solutions, the role and responsibility of a medical coder are changing drastically with new responsibilities being added every now and then.