You could have provided exceptional healthcare service, and your team could have worked dedicatedly, getting the right patient information and creating bills. However, if your coding team doesn't work effectively, then your denials rate will remain high. Coding, audits, and compliance are important parts of RCM services that healthcare organizations need to focus on if they wish to be reimbursed in full at the right time.
A coder's job is to translate basic information like diagnosis, the treatment offered, supplies and services rendered, and unusual conditions and situations that changed the course of treatment into medical codes that the payers would understand.
When the coding is inefficient, incomplete, or wrong, then payers can refuse to pay for the claims, and this leads to rejections and denials.
Coding, audits, and compliance is a part of the RCM process that ensures error-free, legally right, and precise codes are created based on payer requirements and compliances.
Why are coding and audits challenging?
- The first challenge with coding is the constant need to check compliance and regulations. Payers change their policies over time, and hence, the way claims are built needs to change too. Coders have to constantly upgrade their knowledge and stay up-to-date to ensure their codes are right.
- Every small change in the diagnosis or treatment offered changes the codes that have to be used. In some cases, modifiers need to be appended; in other cases, they may lead to denials. So it is important to understand the subject well.
- Coders must go through periodic training and learning to ensure they work effectively and comply with requirements.
- All coding teams must be backed by tools and technology to improve accuracy and ensure human errors are avoided. Such technological backup could be expensive investments that only some teams can afford. When you choose to work with a third-party RCM service provider, make sure you explore their technical strengths.
- Coding, audits, and compliance processesneed to be consistently done to ensure the effects show up in the RCM steps.
Technology-backed coding and auditing
One of the most popular technologies used for coding, audits, and compliance right now is Machine Learning. ML automates most of these processes intelligently. As your coders work on bills, they will be supported by AI, reducing the manual effort needed and improving the speed of coding.
These tools can be tweaked precisely to audit the coding processes based on individual client requirements. Errors can be spotted before the claims are sent out, and this helps claims move forward to the reimbursement stage seamlessly.
Such tools also bring down the overall cost of coding.
Conclusion
Coding, audits, and compliance are, without a doubt, the core strengths of any RCM process. You need to strengthen these to ensure the rest of the processes flow right. Periodical training programs, investment in the right technology, and hiring expert coders are all ways to improve coding and compliance.
Read more:
What is the scope of a medical coding company in India?
How can a medical billing company in India affect healthcare revenue cycle management?
The strategic advantages of hiring a third-party medical billing company in India
