In such a scenario, clinics offer excellent small business opportunity to doctors but, management of clinics is a big thing because although the number of doctors available in a clinic would be low, there would be a steady stream of patients walking in making it challenging to handle the clinic tasks efficiently. Maintaining clinic premises, equipment, and very crucial patient records gets difficult for the clinic owner or management. Moreover, there are certain legal and statutory compliance issues that need to be met in order to avoid any kind of legal issues. To ensure that all clinical establishments provide certain minimum standard facilities and services, the central government has introduced The Clinical Establishments (Registration and Regulation) Act, of 2010.

As per the Clinical Establishments Act, various standards are prescribed for different types of allopathic clinics which include –

1. Standards for clinic/polyclinic only consultation
2. Standards for clinic/polyclinic with observation/short stay
3. Standards for clinic/polyclinic with dispensary
4. Standards for clinic/polyclinic with diagnostic support
5. Standards for dietary counselling centre
6. Standards for the hospital (level 1, level 2, and level 3)
7. Standards for mobile clinic-only consultation
8. Standards for mobile clinic with the procedure
9. Standards for mobile dental van
10. Standards for dental lab
11. Standards for physiotherapy centre
12. Standards for wellness centre – executive health check-up
13. Standards for integrated counselling and testing centre
14. Standards for speciality/super-speciality specific

Apart from these standards, the government has prescribed standards, some of which are in the draft stage yet, for the clinical establishments of –

1. Ayurveda
2. Homeopathy
3. Naturopathy
4. Siddha
5. Sowa-Rigpa
6. Unani
7. Yoga

The Clinical Establishment Act (CEA) is applicable in a majority of the states and union territories. The states and union territories where CEA is not applicable have their own Act. Doctors or people who wish to establish any kind of healthcare establishment have to follow the standards or guidelines as prescribed by the central government or the respective state government.

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.

Revenue cycle management (RCM) is the management of finances, a crucial process that keeps an organization going on a daily basis. If facilities do not focus on their financials they would be scrambling no matter how excellent their patient care would be. In order to have an efficient revenue cycle, it is necessary to understand the various steps involved. Here are the various steps that are a part of the revenue cycle management and help a facility stay strong and healthy.

• Implement the process: The first step in the revenue cycle process is implementing the RCM software or outsourcing the process to RCM services providers who are adept at handling the process with exceptional efficiency. For healthcare practices that have limited staff expertise or large organizations that have branches, outsourcing is the best approach so that they can focus more on their core job of providing quality patient care rather than worrying about the financial matters.
• Patient access: This forms the basis for the entire RCM process where the effective functioning of the front office staff can minimize the claim denials and rework at a later stage. In this process, it is essential to check on the eligibility and benefits for patients.
• Pre-authorization: Prior authorization or pre-authorization is the next step in the revenue cycle process where the RCM services professionals have to obtain approval from the health insurer for the healthcare service, treatment plan, medications, or equipment to be used or performed that they are medically necessary for the patient. Pre-authorization is a pre-requisite for certain services with some exceptions in case of an emergency. However, one point to be noted is that pre-authorization doesn’t guarantee reimbursement of the cost.
• Claims submission: Payments for services performed will not be received until accurate claims are not submitted by the office. Practice management software comes handy for the process of automatic claims submission. Where the RCM process is outsourced, the RCM services professionals need to submit the claims and ensure that they are flawless. In the case of any denials, the cause of denial has to be resubmitted post rectifying the errors.
• Reimbursement for services: Once the claims are submitted, it is time when the insurance payers have to reimburse for the services provided. The payers would verify the procedures with their charges and check the insurance coverage limit. They would check if the bills are accurate and reimburse for their services.
• Collections from patients: When the reimbursements do not cover the services provided fully, then for the outstanding amount the RCM professionals have to send the bill and follow up with the patient to collect the amount from the patients. Medical billers who are an important part of the revenue cycle process have to rigorously follow-up and ensure that the patients pay the total amount.

Performing all the steps properly and in a timely manner will help streamline the revenue cycle effectively. Every healthcare facility whether small or big will need proper revenue cycle management which can be provided by the RCM services providers.

As the number of patients are increasing their data need to be transcript in the form of codes to avoid confusion and need to make it understand internationally so the data provided by patients related to their diseases and prescription everything is transcribed into codes and stored for the use of third parties or insurance companies which will use these codes and calculate the amount of claim that hospital should receive

Below are a few reasons that you should consider a career in this field….

Reasons for considering a career in medical coding:   

1. Profession in Demand: Work in a profession that is in demand and hopefully will remain in demand even though there are some software to assist but there will not be a substitute for people who enter the details and codes related to the illness of patients.
2. Important role in Health care: It plays an important role in the health care industry as the need for transcription and storage of details is becoming a high priority, medical coders play an important role as they can’t be substituted by any software, and also insurance claims depend on these medical codes to calculate the claims it plays an important role in the administration of Health care industry.
3. Job Opportunities: As the demand for this field is increasing everyday proportionately the employers are increasing and the job opportunities are also increasing. People who don’t want to work as permanent employees can also look at freelancing as another option.
4. No prerequisite: Need not be a graduate in pharmacy or any other related field to be a medical coder, any graduation with basic training would be enough to become a medical coder.

Basics of medical coding:
In medical coding training, students are taught how to view patient’s medical reports and assign codes to the diseases mentioned in the reports based on international numeric or alphanumeric codes. The students should be careful while assigning codes else it might cause a problem for the hospitals while getting bills paid through insurance claims. The course contains basics like ICD (International Classification of Diseases)-10 and HCPCS (Healthcare Common Procedure Coding System), published by WHO (World Health Organization) in compliance with insurance requirements. It is basically a backend technical task that deals with the responsible transformation of funds from insurance companies to hospitals.

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