Medical coding is a key component of the claim cycle and is necessary for claim reimbursement. Inaccurate coding can affect your practice in many ways, which can lead to missed revenue, potential overpayments, and allegations of abusing reimbursement policies. Inaccurate coding may also result in staffing challenges as the demands of follow-up on claims denials increase. In this blog post, we’ll focus on ways that practices can improve medical coding accuracy and avoid the consequences of inaccurate coding.
Contracting with a consulting or auditing organization to perform an independent third-party audit is a great starting point when determining where your practice should focus in order to improve medical coding quality and accuracy. Not only is your practice being proactive, but audit findings can guide you to the areas that need the most attention and help you avoid unknowingly committing abuse of reimbursement policies or missing out on valuable revenue opportunities. After each audit, consultants or auditors should educate the practice regarding areas in which to improve, and subsequent audits should ensure that previously identified areas of struggle have been corrected or addressed. Practice size, patient type, and regulatory changes should all be considered when determining how frequently to perform audits. A consultant can help you determine what cadence and sample size are best for your practice, but at minimum, the Office of Inspector General (OIG) recommends that at least 5 patient charts per provider per year are reviewed.
Documentation is perhaps one of the easiest ways to improve medical coding accuracy. The more detail a provider includes in his or her documentation, the higher the reimbursement. When documenting your visit with the patient, it is important to remember that reimbursement is based on what exists in the medical record. If your practice struggles with documentation, consulting with a Clinical Documentation Improvement (CDI) Specialist could be insightful and helpful. The CDI Specialist can review your process and guide your practice through proper documentation to help improve coding as well as obtain maximum (and compliant) reimbursement.
Coding rules and regulations change frequently to adapt to the needs of health care. Medical coders spend years perfecting their expertise by gaining experience and obtaining certifications, hence why partnering with coding experts is certainly one way to improve coding accuracy and maximize reimbursement. Coders can help to fill documentation gaps and provide valuable feedback and education to providers. When hiring or partnering with a medical coding company, consider the following:
While there are many solutions that exist, it is important to find the right strategy for your team and implement best practices to avoid adverse effects of inaccurate coding. pMD’s team of billing experts is here to help you every step of the way so that you can focus on what matters most. Leave the rest to us!