Building Empathy into Revenue Cycle Management: The Tegria Approach
The Tegria Blog Feb 05, 2021
If you could assign a noise level to each area of your revenue cycle, in what decibel range would medical coding fall? Often overlooked and sometimes not even recognized as part of the process, coding is usually “quiet” — when it’s done right and there is a solid strategy in place, that is.
However, with continuous regulatory changes and staffing pressures — and sometimes a lack of top-down focus — coding can begin to look like a cluttered desk. At first you don’t notice the extra papers, but as they accumulate into stacks and your visible surface space disappears, the time-consuming task of dealing with the backlog and finding a workable solution going forward is simply overwhelming.
That’s why leaders who are looking to optimize performance and maximize efficiency overall should never turn a blind eye to coding.
Medical Coding is Vital to Your Revenue Cycle
Coding lives mid-cycle, pretty much smack-dab between scheduling and receipt of payment for the care rendered. It’s not patient-facing, and it’s not particularly glamorous (that is, unless you hire rock star coders). But, accurate coding leads to a clean claim, which results in prompt reimbursement, and that’s why coding impacts your bottom line profoundly.
Point blank, good quality coding means charges get out the door correctly and quickly. And that results in prompt and accurate payment for the services you provide.
It’s quizzical, then, that some healthcare organizations throughout the nation — even the prestigious ones — don’t think of coding as part of revenue cycle operations. Often coding answers to an HIM or compliance director rather than to a financial leader, which only perpetuates the communication gap and lack of collaboration between coding and billing.
To understand why coding and billing need to learn to speak the same language, consider preventive versus diagnostic care. Under the Affordable Care Act, insurance plans cover preventive care without patient cost sharing (that is, without co-pays, coinsurance, or deductibles), but services that are not classified as preventive care are subject to cost sharing. It is important for physicians and their coding and billing staff to differentiate between the two — and to catch each other’s errors — in order to avoid blindsiding patients and avoid experiencing a revenue loss.
When coding is revered as part of your revenue cycle, efficiency and communication improve, and that’s a sure win.
Medical Coding May be Slowing Down Your Process
Bottlenecks can occur anywhere in your revenue cycle, and coding is no exception. Your volume of charts to code might be large and ominous. You might be understaffed. Your coder productivity may suffer as the result of inefficient workflows.
When the pace of coding slows, revenue cycle performance is impacted.
If you have a backlog of charts to code, you risk missing the timely filing deadlines set by payers. The issue here is almost always understaffing in the coding department. Coders today come at a premium price, and hiring, training and retaining the good ones have associated costs, too.
Most information systems allow customizable edits to stop claims with errors from going out the door. They can drive automation with solutions like coding crosswalks for specific payer requirements. But sometimes, a crosswalk is mapped to the wrong code, resulting in denials. It takes an eagle-eyed coder to discover errors of this nature so that they can be corrected within the system. Straight up, not every coding department takes time, or enough time, for system edits.
Working denials is a time-consuming, multi-step process that includes determining the reason, researching, re-coding, and re-submitting, all under yet another deadline. And honestly, few coders love to work denials, especially when they are already busy with new charges, which always hold the priority. Further, many coding operations are so focused on “working” denials that they miss opportunities to prevent them by identifying trends and putting in place proper solutions. Are new system edits required? Is there a coder-education opportunity to prevent repeat errors?
Big-picture thinking about how to prevent errors is a must, and it goes way beyond just correcting and re-submitting them.
The Bottom Line
Coding might not be the first thing that comes to mind when you have problems in your revenue cycle, but we assure you, after partnering with dozens of healthcare organizations of every size and shape across the nation, that having competent, efficient coders whose work blends seamlessly into the revenue cycle will result in fewer denials and quicker, more accurate adjudication.
In this way, coding can stay “quiet” for the right reasons, and you’ll avoid that unnecessary clutter on your revenue cycle desk.
The Tegria Blog Feb 05, 2021
The Tegria Blog Mar 29, 2021
The Tegria Blog Apr 05, 2021
The Tegria Blog Jun 18, 2021