Seven ways medical practices can leverage certified medical coders
What’s the best kept secret to generate and retain medical practice revenue? A certified medical coder. Earning about $56,000 annually, these individuals spend the bulk of their time translating medical diagnoses, procedures, services, and equipment into alphanumeric codes for billing and treatment. It may sound pretty technical (and it is), but what’s most important to understand about the work of medical coders is that they possess extensive knowledge of complex healthcare rules and regulations—knowledge that can help physicians run profitable medical practices.
Consider the following seven ways to leverage certified medical coders to promote revenue integrity:
1. Identify missed revenue opportunities. Certified medical coders know the ins and outs of coding guidelines, and they also understand the very nuanced workflows associated with claims processing. Thus, they can quickly identify areas of underbilling (e.g., cases where physicians can justifiably bill a higher-level evaluation and management code based on patient acuity). They can also look for missed charges, follow up on outstanding accounts receivable, and monitor for insurance underpayments.
2. Audit medical claims. Experienced medical coders have likely read hundreds or even thousands of medical records and can easily pinpoint areas of noncompliance. For example, they’re highly qualified to perform retrospective and pre-bill audits to identify compliance problems such as incorrect diagnosis and procedure codes, upcoding, insufficient documentation, and other types of medical coding errors.
3. Stay on top of regulatory changes. As part of their certification, medical coders must obtain continuing education credits. This means they must stay on top of new and revised medical codes, new payer requirements, new Office of Inspector General (OIG) targets, and more. Then they can educate physicians and staff about important changes such as Cigna’s new modifier -25 payment policy or telehealth rules that continue to evolve in the wake of the end of the public health emergency.
4. Implement operational best practices. Certified medical coders often attend networking events, conferences, and other educational opportunities where they learn about operational best practices and ways to improve medical coding compliance and revenue integrity. For example, they might learn how other medical practices have streamlined prior authorizations or developed a telehealth compliance checklist.
5. Identify root causes of denials. Certified medical coders can leverage technology to not only identify denial trends but also pinpoint exactly why those denials occur. For example, is it a lack of timely filing? Inaccurate demographic or insurance information? Unspecified diagnosis codes? Invalid medical codes? Noncovered services? Lack of medical necessity? Credentialing issues? Something else? With electronic payment posting, certified medical coders can run reports, quickly identify errors, and promote clean claims moving forward.
6. Switch to a new electronic health record (EHR) or practice management (PM) system. Switching to a new EHR or PM system can be a daunting task, but not necessarily with the help of a certified medical coder who can identify much-needed features (e.g., telehealth, electronic prescribing, and a patient portal) and assess usability.
7. Establish and monitor key performance indicators (KPI). Certified medical coders know exactly what KPIs are important (e.g., denial rate, net collection rate, first pass collection rate, and days in accounts receivable) and can gather the data necessary to monitor them. This helps physicians keep tabs on the financial health of their practice.
One challenge? The medical coder shortage.
Here’s one challenge today’s medical practices may encounter: There’s a shortage of certified medical coders. The demand for these specialists simply outweighs the supply. Outsourcing may be an option. Another option may be to hire a part-time certified medical coder that’s a shared resource with another practice. There are many creative solutions to consider, all of which yield the same benefit: The ability to leverage a certified medical coder to improve revenue integrity and promote short- and long-term financial sustainability.
Conclusion
Certified medical coders are an incredible asset for today’s medical practices striving for revenue integrity. If you can’t find one in your area or aren’t sure whether you want to hire one full- or even-part time, outsourcing may be a viable option. Learn how edgeMED can help and be sure to check the Healthy Snacks blog for more expert insights, best practices and industry trends.
