Coding Compliance and Strategies to Improve Reimbursements

Compliance, i.e. acting according to established guidelines and specifications, with respect to the prevailing standards and regulations is vital for every business. So it is, for a healthcare facility in various aspects including medical coding and billing processes. Healthcare facilities must adhere to the various regulations designed to avoid and minimize the scope for fraud and abuse. If you are a medical coding professional you must familiarize yourself with the various compliance rules and regulations and comply with them for the benefit of your career, the healthcare facility’s success and the improvement of healthcare quality in general.

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.

Coding Compliance and Strategies to Improve Reimbursements