The Role of Automation in Modern Revenue Cycle Management: Increasing Efficiency and Reducing Errors
Revenue cycle management (RCM) is at the heart of every healthcare organization’s...
August 5, 2024
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.
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:
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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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?
For specialists, paying attention to accurate medical coding is particularly beneficial. You enjoy all the advantages listed above, plus these benefits:
Fortunately, there are solutions for medical specialists seeking to improve coding accuracy. These include the following:
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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:
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:
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Ready to start improving your coding practices for better revenue cycle health? Here are some actionable tips you can use today for quick results:
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