The business of running a healthcare organization is complex and constantly changing, given market conditions, government regulations, payer requirements, and patient demands. To ensure financial stability in light of these complexities, having smooth running revenue cycle management (RCM) processes is critical.
One of the most important RCM processes for practices of any size is ensuring accurate medical coding and billing for optimal payer reimbursement. However, medical billing errors are all too common in healthcare practices and can significantly hinder cash flow and profitability. Every practice should have as their top goal to reduce patient billing errors.
With decades of RCM experience at Unislink, we understand the importance of accurate medical coding and clean claims for stable financial accounting in healthcare. With that in mind, we’ve compiled this list of 10 powerful strategies that will help practices dramatically reduce coding and billing errors, improve RCM efficiency, and boost a health group’s bottom line.
These are standard practices employed by our UnisLink RCM team when working with any healthcare practice for efficient medical claims management and optimal reimbursement.
Top Ten Ways to Reduce Errors in Medical Coding and Billing
1. Prioritize Patient Insurance Verification
Incorrect or outdated patient insurance information is a leading cause of claim denials with medical billing. It’s fundamentally important to verify patient insurance eligibility and benefits before a service is rendered.
Practices should embrace advanced electronic eligibility verification tools to ensure accurate and up-to-date information before the first visit. By verifying the patient eligibility up front, practices can be sure to be reimbursed for their valuable services.
2. Invest in Ongoing Coder Education and Training
Medical coding is a complex and ever-evolving field. Regularly invest in your coding staff’s education and training. Encourage them to stay up-to-date on the latest coding manuals,coding updates (like ICD-10-CM and HCPCS Level II), and regulatory changes.
Consider certifications like Certified Professional Coder (CPC) to ensure a high level of expertise. Encouraging certification through recognized organizations, such as the American Academy of Professional Coders (AAPC), ensures that your team possesses the necessary skills and knowledge to perform their tasks accurately.
Many practices find this step difficult with staffing shortages and frequent turnover. That’s why hundreds of practices have outsourced their medical coding to UnisLink’s highly experienced team of certified coders with its proven record of accuracy.
3. Implement a Robust Quality Assurance (QA) Program
Establish a comprehensive QA program to identify and rectify medical coding and billing errors before claims are submitted. By catching errors early in the process with pre-billing audits and feedback loops, healthcare providers can avoid costly denials and rework, leading to faster payer reimbursement and improved cash flow.
This program should include regular audits of randomly selected charts, reviewing rejected claims for common errors, and conducting ongoing staff training based on identified weaknesses. Investing in proactive coding error prevention programs is much more cost efficient than continuing to manage a high denials rate.
Many times, practices will hire qualified management and commit to ongoing training, but not invest in a regular program of QA audits with support of the entire practice. This step is necessary to ensure the team continues its high performance, in spite of turnover and management changes.
There is no internal shortcut to hiring qualified staff, regular biller training, and tight RCM processes with quality control programs.
4. Standardize Processes and Procedures
Streamline your coding and billing processes by creating and enforcing clear guidelines and protocols. This includes standardized templates for documentation, established coding conventions, and well-defined claim submission procedures. Consistency minimizes errors and ensures efficient workflow.
Continual changes in coding requirements are expected and documentation must be updated accordingly. This requires a dedicated team to stay on top of these changes and update documents for distribution and training as needed.
5. Foster Clear Communication Between Providers and Coders
Coding accuracy hinges on clear documentation. Encourage providers to document diagnoses, procedures, and medical necessity thoroughly and specifically within the EHR. Continued investment in provider training is required to keep up with coding changes and regulatory requirements.
Implement a system for coders to easily communicate with providers regarding any clarification needed before assigning codes.
6. Employ Effective Claim Tracking and Follow-Up Systems
Don’t let denied medical claims languish. Implement a system for timely follow-up on denied claims. Analyze denial reasons, appeal rejections with clear and concise supporting documentation, and track claim resolution progress to ensure maximum reimbursement. Once denied claims are resolved develop feedback loops that prevent future denials.
7. Embrace Automation for Repetitive Tasks
There’s a reason robotic process automation is revolutionizing healthcare. Leverage automated solutions for repetitive tasks like address verification, coding for common procedures, and claim submission. This frees up your staff’s time for critical tasks that require human expertise and analysis.
8. Leverage Technology for Real-Time Claim Scrubbing
Manual claim processing is prone to medical coding errors. Implementing electronic health record (EHR/EMR) systems with built-in, real-time claim scrubbing features can be the game-changer for medical billing accuracy.
These systems automatically verify patient demographics, eligibility, coding accuracy, and missing information before submission, significantly reducing denials and delays.
9. Partner with a Reliable Clearinghouse
A robust clearinghouse can significantly enhance your RCM efficiency and reduce errors. Look for a clearinghouse that offers features like real-time eligibility verification, claim scrubbing, and denial management tools. Consider services that provide detailed reporting and analytics to identify trends and further refine your coding and billing practices.
10. Embrace Data Analytics for Continuous Improvement
Regularly measure your coding and billing performance through key metrics like first-pass claim acceptance rate, denial rate, and collection rate. Analyze these metrics to identify areas for improvement. Implement corrective actions based on the findings, continuously refining your processes for optimal efficiency.
RCM data analytics is a powerful tool for identifying trends and patterns in coding and billing errors. By analyzing data on denials, rejections, and other key performance indicators, healthcare providers can pinpoint areas for improvement and implement targeted interventions.
Accurate Medical Coding and Billing is Required for Long-Term Success
By implementing these strategies above, you can dramatically reduce coding and billing errors, improve RCM efficiency, and boost your healthcare organization’s profitability. Remember, accurate coding is an ongoing process. Continuous improvement and vigilance are key.
Outsource RCM Processes for Improved Accuracy and Profits
Many practices have a difficult time finding highly skilled and experienced RCM staffers with a proven track record of ensuring accurate medical coding and billing. That’s why they choose to outsource to a qualified medical billing services company who can guarantee better performance and more profits.
At Unislink, we are passionate about helping healthcare providers achieve financial success
Our team of experienced medical coding and billing specialists can provide a comprehensive suite of services tailored to your specific needs. We offer services including:
- Professional medical coding and billing
- Expert coding audits and reviews
- Revenue cycle management optimization
- Educational resources and training programs
Contact Unislink today to discuss this topic and learn more about how they work with healthcare groups of all sizes to streamline RCM processes, minimize errors, and maximize the bottom line.