• Analyze rejected/denied claims – Your practice may experience claim rejections/denials from time to time. You need to check if these rejections/denials occur rarely or they are occurring regularly. If they have become a common thing in your practice and you have a denial rate above five percent, it means you need to study your coding, billing, and claim submission processes and analyze the reason for your denials. You should ensure that there is proper communication between the healthcare staff, people in medical coding jobs, and medical billers to make certain that the right codes are used for the procedures performed and they are rightly presented in the claims.
• Train staff adequately – For accurate assignment of medical codes to various diagnostic and other procedures it is essential that you train your personnel in medical coding jobs with the latest updates in the different coding systems. Not just the medical coders, but your physicians and other healthcare staff should also be aware of the latest updates and regulations related to documentation and coding. Ongoing training programs help the medical coders and other staff to stay updated with the latest changes in the various coding systems thus, minimizing the chances of coding errors.
• Avoid interruptions – It is estimated that an average team member takes around 20 minutes to return to his/her task with full focus when interrupted. So, it is essential that you ensure your medical coders have no or minimal interruptions by reducing irrelevant team meetings and asking them to mute their social media notifications. This way, medical coders can concentrate on their work without any distractions.
• Limit non-coding tasks – Ensure that your medical coders are doing the work of assigning codes only. If they are playing dual roles by taking up some other additional responsibilities like scheduling, they would be unable to focus on their major task and this may affect their efficacy while assigning codes. As a healthcare facility, if you want correct reimbursements from your insurance companies or want full collections from the patients’ payments, you should ensure that your coders are doing the right job.
• Implement audits – Implement periodical coding compliance audits that can bring the coding issues to the fore and help you address them effectively. Keep your coders informed about the audits and make them understand that these are to improve the quality of coding and are not to assess and punish the coders.
• Outsource – To get the most efficient coding results, you may turn to medical coding services companies that perform the coding and billing tasks for you efficiently. By outsourcing your medical coding process, you will not need to track all the latest coding updates and train your staff as necessary.

Medical coding has a significant impact on your facility’s revenues and hence, you should take proactive measures to identify the issues in your coding process and rectify them. Above mentioned are some of the actionable tips you can practice to eliminate coding inefficiencies and deal with issues like staff shortage, etc. in your healthcare practice. Choose the best medical coding company and outsource your coding process for exceptional coding accuracy and efficiency.

Why RCM Process?

RCM process involving various aspects such as medical coding, medical billing, collections, and data analytics aids in the efficient running of a healthcare facility leading to better financial outcomes and improved patient care. Poor billing practices in a healthcare facility can lead to monetary losses resulting in a potential decline in the quality of care being provided; thus, it becomes critical for every healthcare facility to have a robust RCM process in place.

An effective RCM process ensures that right from the moment a patient comes to a facility for initial inquiry to the time when the final payment is received, the patient interaction is managed competently. The various aspects of the RCM process ensure that all the essential and appropriate information is collected and documented accurately aiding in billing only those services that are provided. Further, the RCM process enables contacting the payers or patients timely and collecting the due payments promptly avoiding denials and bad debts. After all, nobody likes bad debts and losses.

However, revenue cycle management involves multiple and complex patient interactions and mismanagement of any of these interactions can adversely affect the patient and clinical satisfaction scores damaging the reputation of a facility, halting its growth, and creating uncertainty for its financial performance. This is the reason every healthcare facility, irrespective of its size or health system, must prioritize revenue cycle management and revenue collection.

Steps of the RCM Process

• Preregistration: This is the first and most crucial step of the RCM process that allows a healthcare facility to collect important patient information including demographic data, insurance information, and eligibility for insurance. This step helps the facility check the patient’s insurance coverage, deductibles, co-insurance, and co-payments.
• Registration: This step further strengthens the aspect of collecting accurate information from the patient. The patient’s details such as phone number, address, date of birth, and insurance details are verified every time a patient is provided treatment regardless of whether the patient is new or established. This step, if performed diligently, can help avoid many issues at later stages.
• Charge capture: This is the step where medical services provided are transformed into billable charges. Accurate documentation of every service plays a critical role since these need to be submitted for payment from patients or insurance providers.
• Claim submission: In this step, information is sent to the insurance payer after entering the charges where it will be verified if the diagnosis and procedure performed are aligned.
• Remittance processing: This step involves applying or rejecting payments where allowable and write-offs are determined.
• Insurance follow-up: This is the step where the healthcare facility analyses the paid and unpaid amounts through the accounts receivables report.
• Patient collections: This is one of the toughest parts of the whole revenue cycle process where patient balances are determined and the amounts are collected from the patients.

A healthcare facility gets paid for the services delivered only when all these steps are performed diligently and accurately. Thus, the RCM process aligns the clinical care aspects with the business aspects and helps the healthcare facility function efficiently and successfully.

Build Your Career

Revenue cycle management is a key process for healthcare facilities and is a great career choice. Avontix, a National Medical company, is the leading RCM services provider catering to US healthcare facilities and offers rewarding careers in healthcare documentation, medical coding, medical billing, and AR calling.

Join the leading revenue cycle management services company and enrich your career with exciting opportunities.

 High-deductible Insurance Policies:

Let us see what high-deductible insurance policies are that are leading to collection challenges. For insurance plans, one needs to pay premiums. A high-deductible insurance plan is one that has a higher deductible than a traditional insurance plan. In such a plan, the monthly premium one has to pay is generally low; however, the policyholder has to bear more health costs (deductible) before the insurance provider starts to pay its share. Here, it’s necessary to understand what a deductible is. It is that portion of an insurance claim that the insured has to pay out of pocket and only upon paying this amount the insurance company will pay the other portion. So, from the healthcare facility’s point of view, when a patient with a high-deductible insurance policy is treated, the onus is on the billing department to collect the deductible from the patient.

High-deductible health plans are the only way to qualify for a ‘Health Savings Account’ that gives tax benefits. These plans are usually suitable for young and healthy people who generally don’t need health coverage with the exception of a severe health emergency. These can be opted for by wealthy people as well who are capable of paying the high deductible but want the benefits of the health savings account.

The rising popularity of high-deductible insurance plans is forcing some patients to delay paying their medical bills. In these difficult times of the pandemic when people are battling with not just health issues but employment and financial crises as well, collecting from patients has become a great challenge. This may result in an increase in money owed to healthcare facilities by patients and lead to bad debts over time.

In these tough situations, healthcare facilities must be careful in dealing with their account receivables and even consider sending their patients to collection agencies more quickly if they doubt them to be neglecting or trying to evade their out-of-pocket payments. It is even noticed that many healthcare facilities have started asking for payment before the service is provided to avoid collection issues later on.

Other aspects like claim denials are also adding to the burden of medical billers. Avoiding and managing claim denials effectively is essential to improve the efficiency of the revenue cycle of healthcare facilities. It is commonly observed that insurance companies can deny medical claims citing minute data errors and discrepancies. Sending accurate medical claims is of great importance because a denied claim costs both money and time for the medical billing department to resolve the issue. Submitting error-free claims is the best way to minimize denials and get your timely reimbursements, thereby improving your revenues. For this to happen, it is imperative to have a robust revenue cycle management process in place with adequately trained staff and cross-verification procedures in place, before submitting claims.

To achieve a healthy revenue cycle, healthcare facilities must either hire experienced and well-trained medical coders and billers or outsource their revenue cycle process to medical billing companies like Avontix, which offers exceptional medical billing services and help facilities focus on their core operations without worrying about their collections.

Is Medical Coding Career Dying?

No, medical coding is definitely not a fading career. Technology and artificial intelligence are indeed bringing about enormous changes to the medical coding profession, however, medical coding is a high-skill and human-intelligence-based profession. For accurate medical coding reports, there’s a high need for human analytical skills. But, it is also imperative that the current and aspiring coders should learn how to use technology to their best use and minimize the time spent on routine tasks.

Although medical coders have been specializing in specific areas for a long time, the demand is consistently rising for specialist coders and there is a great scope for market growth for such specialists. The nuances of various specialities and picking up relevant information from vast and detailed records require human analytical skills that are not possible with only technology-based coding.

Also, medical coders work extensively with protected health information (PHI) to communicate accurately with insurance companies. It is well understood that coders working with protected health information need to be completely familiar with and compliant with the Health Insurance Portability and Accountability Act (HIPAA), and thereby require having in-depth knowledge of HIPAA. Only human intelligence can balance the coding requirements and HIPAA compliance to provide timely and accurate coding inputs for medical billers and help prevent and reduce medical claim rejections and denials.

The major factor that influences the need for medical coders is that several grey areas cannot be classified under ICD codes uniformly by different coders. Medical coders use their analysis and judgment based on the information available to them and different coders can code the same procedure in different ways with a reasonable explanation. There are some issues that technology cannot solve aptly because some rules are contradictory, some descriptions are vague, and some instructions use soft language. The medical coding field is more related to the art of analyzing and interpreting than the mere science of applying codes rigidly.

Another factor that contributes to the choosing of medical coders over automation is that policies and regulations related to medical coding change frequently and only a human mind can figure out the exact and relevant policies and regulations while coding for accuracy.

So, although there is a scope for technology to take over human intervention in the medical coding field, there are still some aspects/issues that cannot be resolved with the currently available technological knowledge. It may take nearly two decades for technology to advance to a point where software programs are developed that can do medical coding without the involvement of a human brain and when an organization does not need a medical coder for its coding purposes. Hence, it can be said that medical coding will stay for some more time and aspirants can definitely choose a career in medical coding without any apprehensions. Avontix is one of the best medical coding companies in Hyderabad that offer excellent training and growth opportunities to its employees.

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.

• 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.