Quality coding is essential for a healthy revenue stream. Superior coding can reduce denials, improve cash flow, facilitate faster and more accurate reimbursement, and decrease “takebacks” and penalties. It is estimated that 42% of denials are caused by coding issues. With payers denying more claims than ever—more than one in ten in 2022—practices cannot afford to ignore coding issues.
The Complexity of Specialty Coding
Medical coding is particularly challenging for specialty practices as there have been numerous revisions to existing codes and now requires increasingly complex clinical documentation. For example, specialties like cardiology experience ongoing contractual changes and amendments to their procedure rules. And cardiology coding includes intricate combinations of codes, making them more time-consuming to manage and elevating the likelihood of errors. Besides cardiology, other specialties that include difficult coding include nephrology, ophthalmology, orthopedics, pediatrics, and radiology.
Building a High-Performing Coding Team
The most impactful step practices can take to elevate coding quality is to implement an ongoing, stringent training program. Coders should be required to achieve a coding accuracy level of 95% or above. Practices may want to offer incentives for reaching this benchmark. A quality coding training program should also include certification from the AAPC or AHIMA. Once certification is completed, coders should be required to pursue continuing education credits to help them build their knowledge base and level of expertise.
While medical coding will always require a human touch, computer-assisted coding (CAC) can be a game-changer in terms of quality. CAC uses natural language processing (NLP) to interpret a physician’s notes, matching phrases, diagnoses, and procedures with the correct codes. This streamlines and improves the accuracy, completeness, and compliance of clinical documentation. The result is fewer denials and more timely reimbursement.
The increasing Popularity of Outsourcing
Practices struggling with staffing shortages and cash flow issues may find it challenging to invest the resources necessary to implement training programs, CAC, audits, and reviews. That’s why many find it preferable to outsource portions or all of their coding needs. When choosing a partner, there are some important capabilities to look for, including the following:
- Comprehensive coder training program, including national certification
- An emphasis on clinical documentation improvement (CDI), including physician training
- Coders with broad payer expertise
- Investment in the latest automation technology
- Coding auditors with extensive experience
- Coding accuracy rate of 95% or higher
- Proven record of success in reducing denials, takebacks, and A/R days
The Time to Act is Now
Practices are facing unprecedented revenue pressures right now. Taking a fresh look at their coding quality can help reduce denials, payer takebacks, and cash flow issues. Implementing intensive coding training, CAC technology, and internal audit and review programs can help. But for practices that lack the resources to make such investments, outsourcing may be a better approach. It can take years for new coders to develop the level of expertise that outsourcers can provide. Because outsourcers typically have more experienced staff and more advanced technology, practices can achieve the highest levels of coding accuracy faster and with less effort.