4 Key Steps to Make Coding and Billing as Coordinated as Your Care
In July 2016, the Centers for Medicare and Medicaid Services proposed new bundled payment models that continue the ongoing progress to shift Medicare payments from rewarding quantity to rewarding quality by creating strong incentives for hospitals and clinicians to deliver better care to patients at a lower cost. This “better care” relies on better-coordinated care — streamlined, thorough and seamless — and that goes for your back-office operations, too. In order to maximize the returns on these lump-sum payments for entire episodes of care your cording and billing has to ensure as fast a return as possible on your claims. Here are four ways to make back-office processes as coordinated as your care.
1. Get your documentation in order
The traditional model of unassisted physician documentation inadequately captures reimbursement for physician specialists and can compromise the perceived quality of their medical care through insufficient documentation. Using medical scribes to complete documentation in real-time, at the point of care, assists with provider flow, patient advocacy and provides a quality assurance/quality improvement process where others do not. In addition, certified medical scribes are trained not only in efficiently using electronic health record (EHR) systems, but also in documentation techniques for meeting the near-granular level of specificity that ICD-10 requires. With thorough, complete documentation that’s optimized for ICD-10 claims submission, physicians, practices and facilities are less likely to see significant cash-flow losses.
2. Start coding before the patient is out the door
The coding and billing office cannot — and, hopefully, does not — work in isolation. For back-office staff to succeed by generating accurate codes that appropriately maximize revenue, extra effort and care must be taken to thoroughly document the patient encounter. But ensuring complete and accurate documentation diverts the physician’s attention from care of the patient. Furthermore, physicians have to review claims before submission, and they can be slowed when there are questions from the back office, particularly those that require going back to check the medical record.
Point-of-service coding that links the patient, physician, scribe and medical coder ensures that documentation clearly supports coding, and that accurate codes are generated. LiveCode is an approach that combines personnel and automated workflow processes for same-day coding and bill drop. Medical scribes are able to communicate with QueueLogix coders in a real-time environment where they can communicate and problem-solve together.
These process efficiencies save physicians from spending disproportionate time on checking documentation, because the accuracy was determined while the patient was in the room, and the necessary information gathered and care provided at that time. In addition, the flexibility created in the physician’s schedule means patients can receive more timely care through well-orchestrated processes in place throughout the practice or organization.
3. Ensure claims are clean and denial-proofed
Deficient documentation occurrences and costly physician re-work, and the down-coding that follows can significantly affect the bottom line. It is therefore important that coding and billing accurately reflect what was done during the patient encounter, and vice versa. It’s the old axiom: If it wasn’t recorded, it wasn’t done. EventCare integrates with virtually any EMR/EHR system, aligning clinical activities with back-office operations, to ensure accuracy of codes and completeness of supporting documentation, to prevent claims denials. A “smart” queuing system connects coders with clinical staff so that symptoms can be diagnosed and coded simultaneously. This means the medical coder can relay documentation and care needs to exam-room staff on which codes to use for patient diagnoses as they occur. The result: Physicians and facilities are able to submit air-tight claims and get paid for the actual services that were carried out, rather than an inaccurate-but-supportable set of codes.
4. Minimize days in A/R at the beginning of the cycle
Profitability increases when the revenue cycle is completed quickly. That’s because getting paid faster means the revenue doesn’t depreciate as much which, in turn, means facilities and practices can pay down debt or put the revenue into higher-return investments. However, far too often, the lack of available cash forces groups to borrow, relying on health systems to an unsustainable degree.
Every day, then, that a claim is in A/R costs money, so it’s important to minimize days in A/R at all points in the revenue cycle, starting with the beginning. And the revenue cycle is accelerated when claims are not backlogged for later but, instead, are sent to payors within hours rather than days. Queuelogix resolves the issue of accumulated billing claims by simultaneously processing correctly coded billing claims while the patient is being seen by the physician. This real-time medical billing/coding not only saves time through complete claims and lower clerical burden but, because of the high level of accuracy arising from direct communication between billing personnel and medical scribes during the actual examination, also helps to avoid the headaches of rejected claims. In addition, LiveCode’s real-time patient analytics, dashboards and integrated feedback reduce billing and coding lag times.