With reports indicating denied claims rates are reaching new highs, many medical organizations are scrambling to get their numbers in check.
Considering that denial management costs hospitals roughly $262 billion per year and medical practices upwards of $20 billion per year in delayed or lost reimbursements, denied claims aren’t a matter to take lightly.
Inaccurate medical coding is one of the top causes of denied claims within both medical practices and health systems. With so much revenue on the line, your organization's medical coding accuracy should be a top priority.
How do you achieve higher accuracy?
The secret to medical coding accuracy is the right combination of coding services and technology to augment your current coding/billing workforce or completely take it off your hands.
The right combination of service and technology:
Is up-to-date on all the latest healthcare guidelines and policies
Payors change coding guidelines and policies every year, putting a considerable burden on coding employees to keep up. These annual updates lead to continuous and tedious reeducation and training of your medical billing workforce.
If an employee isn’t up-to-date on the latest guidelines and policies, they could be making erroneous coding mistakes and not even be aware they’re doing so. Even if they only occur a few times, these inaccuracies magnified over thousands (sometimes millions) of claims can create significant negative financial ramifications for your organization.
Utilizing a coding solution that integrates the latest guidelines and policies and can quickly scale new requirements across an entire organization is invaluable to your revenue cycle. Knowing which codes to use leads to more accurate billing, a reduction in denied claims, and an increase in reimbursements.
Is customizable for your specific needs
Every healthcare organization is unique, meaning a one-size-fits-all coding solution won’t generate the best results. The right service and technology combination is customizable and allows practices and health systems alike to keep their existing systems and documentation.
Employ the help of an AI medical coding service that can incorporate a large number of documentation formats or site-specific guidelines to ensure it’ll work for your particular needs.
Some organizations may only want to use AI coding to supplement their existing team and reduce some of their burdens. Some may wish to use a turn-key solution that handles all their coding needs. Or, some may want their team’s work checked after they’re finished.
Finding a tool that not only works for your organization’s unique needs but also integrates existing systems will yield the best, most accurate results.
Guarantees quality improvement
The right mix of services and technology will not only say it can improve coding quality and accuracy but guarantee it through robust offerings that ensure accuracy.
For example, we help our clients reduce the incidence of error by ensuring a complete chart review. Our system looks at every word in a chart to find missing procedures or diagnosis codes and flags any documentation issues that could lead to a potential denial or unnecessary downcoding.
Ultimately, this attention to detail helps organizations boost their accuracy to reduce claim denials, mitigate audit risks, and positively impact their revenue cycle.
The secret is out
Fathom’s up-to-date, customizable services and technology that ensure improvements can help your health system or practice achieve a high level of medical coding accuracy.
Wondering how to boost accuracy within your coding operations?
Photo: Possessed Photography