Decoded: The Importance of Accurate Medical Coding in Revenue Cycle Management

If you manage a specialty practice in nephrology or urology, medical coding is a major part of billing. Coding and revenue cycle management go hand in hand and influence profits. 

This post reviews how coding affects practice revenue and how coding accuracy can help with revenue cycle management. Learn expert tips on how to improve coding accuracy. Plus, get advice you can use today to start protecting revenue for your practice. 

What’s the Significance of Medical Coding in Revenue Cycle Management?

Medical coding is the process of assigning unique numerical tags to patient conditions and treatments. These codes are then used by insurance companies and Medicare to (hopefully) approve reimbursement. 

Payers want to see that care is matched to patient needs. Coding was developed to check for unnecessary treatments or diagnostics. If a bill is submitted with missing or incorrect coding, the reimbursement risks being denied. 

Revenue cycle management is a way of protecting income streams for clinical practices. This includes specialties like cardiology, nephrology, and urology. Timely and appropriate incoming payments are important for business stability and growth. 

You want to get paid in full quickly, just like every other business. But, unlike in other industries, healthcare businesses often experience payment delays. 

One of the best ways to manage revenue cycles and reduce avoidable delays is to make coding as accurate as possible. You can read more about that in the following section. 

The benefits of revenue cycle management include: 

• Steady income streams to avoid dry periods 
• Predictable income for scaling the practice 
• Increased patient satisfaction with fewer claim denials 
• Reduction in preventable manpower hours for fixing claims 

You want as much time as possible to devote to patient care and continuing education. You don’t want time eaten up with adjusting and resubmitting insurance paperwork. Likewise, patients want their claims paid promptly and with as little ambiguity as possible. 

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The Role of Accurate Medical Coding

Let’s talk about the intersection of revenue cycle management and accurate coding in a little more detail. 

How does meticulous medical coding figure in protecting and predicting your practice revenue? 

• It ensures proper documentation, so claims are less likely to be rejected. 
• It reduces partial payments that lower revenue totals when added up. 
• It creates more accurate medical records for future patient care. 
• It allows clinic staff to better foresee trends in both care and income. 

For specialists, paying attention to accurate medical coding is particularly beneficial. You enjoy all the advantages listed above, plus these benefits: 

• Improved patient outcomes and reduced errors affecting morbidity and mortality 
• Higher patient satisfaction scores for better retention and online reviews 
• Increased referral rates from medical colleagues based on clinic efficiency and patient satisfaction 
• Reduced wasted manpower hours on fixing and resubmitting claims, allowing for more time to devote to patient care 

Compliance and Accuracy in Coding Practices

Fortunately, there are solutions for medical specialists seeking to improve coding accuracy. These include the following: 

• Develop a process to review and correct all claims before submitting them. This will improve code accuracy. 
• Be sure to use the most specific codes possible. And include code modifiers for both accuracy and improved reimbursement statistics. 
• Make sure coding and billing staff are clear about the importance of proper coding. They must follow clinic standards for accuracy. 
• Watch out for National Correct Coding Initiative (NCCI) edits. These are contradictory codes that cannot be used together and will be denied every time. 
• Learn whether cases have the proper prior authorization or referral needed for approval. 
• Cut out-of-network cases when possible, which have a higher rate of denial than in-network cases. 
• Perform periodic coding process audits. This will illuminate where your practice needs improvements in coding or perhaps new systems. 

FROM ONE OF OUR PARTNERS: Common Challenges in Revenue Cycle Management and How to Overcome Them 

Denial Management and Revenue Optimization 

One recent national survey showed that overall, 15% of all claims were rejected. Medicare Advantage and Medicaid claims were slightly higher than that average. 

It’s commonly accepted that coding errors made up a serious part of those denials. The goal is to reduce errors for both the best patient outcomes and the best protection of your revenue. The current standard for coding accuracy is at least 95%. 

Why are claims most often denied? Most of these reasons echo key points discussed in the previous section: 

• Failure to use the correct code 
• Code not specific enough 
• Code lacking modifier 
• Too few codes for involved procedures 
• NCCI edits submitted 
• Not correcting codes before resubmitting 
• Variations by insurer, state, and plan level 

Any of these oversights—individually or in combination—can result in undesirable revenue leakage. Above, we discussed some ways this can be avoided. More methods include the following: 

• Help medical coders stay up to date on coding changes, especially regarding Medicare. Nephrology and urology both have a higher percentage of senior patients. 
• Think about outsourcing at least the most complex coding cases. It can reduce human error and ensure complicated submissions are coded properly. 
• Consider employing coding automation software, which reduces human error. This improves coding accuracy and reduces total morbidity and mortality. 
• Leverage other technology where possible for your revenue cycle efficiency. Examples include practice management software to handle accounting, staffing, and patient relations. 

FROM ONE OF OUR PARTNERS: 5 Ways to Optimize Revenue Cycle Management 

Key Medical Coding Takeaways for Healthcare Specialists

Ready to start improving your coding practices for better revenue cycle health? Here are some actionable tips you can use today for quick results: 

1. Speak to your colleagues who also have independent nephrology and urology offices. They may have advice to share on strategies that have worked to bolster their revenue. 
2. Coding often starts in the exam or treatment room. So, keep a list of the most common claims and their associated codes handy in each room. When clinicians note codes in patient paperwork—which happens frequently—they’re more apt to be correct. 
3. Create a habit of double-checking codes even when a physician, PA, or NP has already written the code next to a diagnosis or procedure. It may need correcting, or it may need a modifier. 
4. Clinic managers should make certain to encourage training and education for medical coders. 
5. It’s tempting in a small office to have nurses double as receptionists, billers, and coders to save money. This may save money but cost the practice more in the long run. Give careful consideration to splitting roles. It might mean hiring a qualified coder or outsourcing coding for long-term success. 

FROM ONE OF OUR PARTNERS: 8 Tactics to Improve Revenue Cycle Management for Your Practice