How to Improve Coding Quality for a Better Revenue Cycle?

The revenue cycle is a crucial aspect of a hospital or clinic functioning which includes the entire lifecycle of patient accounts from the time of the first appointment to the final payment receipt. From the year 2020, we have seen several changes in the healthcare sector in terms of diagnosing and treating coronavirus patients. It was a challenge not just for healthcare providers but also the medical coding fraternity who had to learn various new codes related to the disease including the latest entrants of vaccine codes.

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.

How to Improve Coding Quality for a Better Revenue Cycle?