How Does Medical Coding Affect the Revenue Cycle?

In today’s value-based healthcare environment where hospitals and healthcare providers are paid according to the quality of their care, even the slightest deviation in documentation could leave huge gaps in revenue. Clinical Documentation Improvement is even more critical as long as Medicare remains the main payer of hospitals in the United States.

The cash flow of a medical practice is heavily influenced by the efficiency of the staff that handles the billing and coding processes. All healthcare professionals place a high priority on providing quality care to their patients. As the number of patients increases, so does the paperwork that ensures payment. However, as long as you complete this paperwork correctly, there is no need to worry.

Effective billing and coding benefit both patients and healthcare professionals. Billing claims in a way that’s effective will ensure a steady income flow for your business and a higher level of client satisfaction.

Understanding Healthcare RCM Key Indicators

Your ability to successfully use KPIs is key to reducing claims denials and maintaining a healthy revenue cycle. When analyzing KPIs in a value-based approach to healthcare, the effectiveness and documentation of medical coding is crucial. These are governed by two main factors:

  • Productivity of Coding: The number of hours is divided by the total number of records. Efficiency is determined by the least amount of work for the most complicated tasks. A good example of a criterion that is acceptable for determining effective coding productivity would be 24 inpatient coding reports per eight-hour workday. The metric may need to be adjusted due to new coding duties, increased organizational complexity, mixed cases, etc.
  • Coding accuracy: To determine accuracy, the number of errors is compared with the number of codes assigned. No variations are desired. It is important to have a policy document that evaluates the correctness of coding levels since an organization will assign coding levels. Online coding tools and official guides serve as benchmarks to improve coding effectiveness.

What are the benefits of efficient medical billing and coding for your practice?

Here are some of the benefits that precision and efficiency in billing and coding can bring:

1. An Efficient Medical Payment System Reduces the Stress on Doctors and Support Staff by:

Overworked medical professionals and healthcare workers make up the majority of healthcare professionals. The majority of staff time is spent on patient care. Workers can be overworked when they have to submit claims. Inevitably, a claim will be submitted incorrectly or without supporting documentation. This leads to denials, which decrease revenue. Billing services ensure that payments are made on time and allow your staff to concentrate more on patients. Unpaid claims and bad debts will no longer be an issue.

2. Helps to Prevent Medical Billing Errors that Could Have Negative Legal Consequences:

When assigning a code to a therapy, a biller should pay attention to details and look for the exact code of the treatment rendered by the provider. Even the smallest mistake in a medical procedure code can lead to a claim rejection or a delay. In some cases, it may be illegal to code incorrectly. You can avoid legal consequences by using accurate and effective billing services.

3. A Medical Billing System That Is Accurate and Efficient Allows Patients To Get Care Without Worrying About Money. This results in Patient Happiness.

The main objective of the patient when visiting your clinic is to receive recommended treatment. However, they also want a simple payment process. Most patients who seek therapy are covered by insurance, so they want to avoid red tape and have their claims paid in full. Your patients will have fewer problems and your clinic will receive fair compensation for services rendered.

4. Establish a Productive Procedure that Verifies Patient Eligibility Quickly.

A medical billing system that is effective will ensure that eligibility information of patients is checked in advance to avoid claims being rejected and reimbursements not being sufficient. It is important to be familiar with all the latest information and laws regarding insurance payments. A medical coder or biller who is dedicated to the industry will be the only one who can keep up with the latest changes. A professional biller will double-check the accuracy of information with the knowledge of billing he has. This ensures that you get the least amount of claims denied.

5. It is important to ensure that the medical practice has a consistent cash flow and receives prompt reimbursement of claims.

A continuous flow of money into the practice is essential for its survival. This can only happen if there are a few denials of claims. A coding and billing system that is effective will ensure the accuracy and completeness of the reimbursement claims. This ensures consistent and timely payment of claims and helps maintain the general health of the practice.

You can use the advice in this article to improve your revenue cycle management and maximize your collections by optimizing your medical billing.

This post was written by Physicians Choice Medical Billing, LLC. Physicians Choice Medical Billing, LLC has been providing exceptional, and comprehensive Full-Service Practice Management including medical billing, coding, revenue cycle management, credentialing and consulting services to our clients. Whether you are a new startup or an established medical group, PC has the experience and dedication to make your practice a financial success. The staff bring multiple years of experience and dedication. Fingerprinting in Tampa and Fingerprinting in St Pete with Physicians Choice provides the highest quality, professional digital Live Scan fingerprints in a comfortable professional office atmosphere. Physicians Choice offers both individual and corporate account service.