Main Challenges & Opportunities in Medical Billing and Coding Services

Do you think Covid-19’s impact on medical billing and coding services has been dragged to an assertive level? Interestingly, challenges arising from the pandemic have revealed some critical opportunities for improvement. Last year, every news channel was featuring the tremendous efforts of healthcare professionals in fighting against Covid-19. These professionals began to transform healthcare by implementing telehealth and virtual care, standing up new wards in hotels, sports arenas, and schools, and finding new ways to stretch precious supplies.

There was another revolution behind these transformations. 2020 seemed to be one of the most challenging years, especially for medical billing and coding services. Like the clinicians who revolutionized healthcare, revenue cycle leaders had to find better ways to support those clinical transformations on the administrative side of healthcare. Medical billing and coding services also confronted the most significant change to the Medicare Physician Fee Schedule in about three decades on top of frequent off-cycle changes to major medical coding sets to account for the novel coronavirus and related conditions.

This article brings you the main challenges and opportunities faced by medical billing and coding services since the pandemic.

Breaking Down E/M Coding Changes:

  • Few historic changes to evaluation and management (E/M) coding took place on Jan.1, 2021.
  • Since then, new guidelines for American Medical Association have allowed healthcare professionals to select an E/M code based on the total time spent on the date of the encounter or medical decision-making.
  • It means that healthcare professionals will no longer have to rely on a patient’s history or physical exam to determine the appropriate level of E/M coding.
  • Before changes, both, including medical decision making were needed to identify the appropriate E/M code.
  • CMS had decided to finalize changes to Medicare Physician Fee Schedule in 2021 to align with the AMA’s guidance, resulting in the biggest change to E/M coding in 30 years, according to the agency.

Addressing the New Virus:

  • “COVID definitely disrupted our processes,” Ginna Evans, MBA, RHIA, CPC, CRC, FAHIMA, coding educator for IM specialties at Emory Healthcare, revealed.
  • However, Evan was not the only one. Right from the telehealth implementations and social distancing protocols to brand new codes and reimbursement policies, COVID-19 impacted every healthcare organization, even down to the simplest of tasks, like showing up to work in the morning.
  • “At Covid time, I actually had the opportunity to work with several organizations that were kind of transitioning. It was the same problem that had to be solved in each one, which was, how do we make all of our processes remote,” shared Vanessa Moldovan, CPC, CPPM, CPMA, CPC-I, revenue cycle manager at HCA Healthcare and AAPC National Advisory Board member.
  • The first code providers used to document COVID-19 was an International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) emergency code created by the World Health Organization in March 2020 for confirmed cases after April 1.
  • From then, there were at least a dozen new ICD procedure codes related to the virus. Many more changes to the Current Procedural Terminology (CPT) and Healthcare Common Procedural Coding System (HCPCS) code set to account for COVID-19 and related conditions and procedures took place.
  • Healthcare organizations also turned most of the Current Procedural Terminology (CPT), and Healthcare Common Procedural Coding System (HCPCS) code sets to account for COVID-19 and related conditions and procedures.
  • With several changes, surprisingly, it’s that financial leaders at US hospitals and health systems were confused over COVID-19 coding and claim requirements as one of the top issues impacting revenue cycle operations in 2020.
  • Few led to denials, and an internal analysis found that the average hospital claim denial rate increased at a more rapid pace during the height of COVID-19, hitting a new record of nearly 11 percent of claims denied upon initial submission in 2020.
  • “Denials are just going to be out of control, and in my opinion, probably 70 percent of the dollars you’re receiving are not accurate,” said Moldovan.

Spotlight on Learning medical billing and coding services during the pandemic:

  • Education and training are said to be one of the best practices for coding and billing services.
  • Latest updates to coding sets and insurance reimbursement policies necessitate frequent training sessions for both coding and bill team members and clinicians documenting care at the point of service.
  • “One of the things we did that was very successful in terms of telehealth is, we decided, as a team of coding educators, to develop a grid that had different information about the methods of communications with the patient,” Evans stated.
  • “That was the type of education we were trying to push out to providers and to our revenue cycle staff so that the providers knew what they needed to have and the coders knew what they needed to look for in the notes,” Evans said.
  • Finding relevant and important information on time and, more importantly, in one place has worked wonders for Emory staff who were already being stretched thin by the demands of the pandemic.
  • “It gave them a place to go to look and understand what was needed,” Evans explained, “because so many providers did not understand how they could do an E/M visit via telehealth and do a physical exam.”
  • Similarly, she leveraged the telehealth committee to ramp up virtual services ASAP. The team had to meet every day and included providers from each specialty and revenue cycle staff, so everyone was on the same page about how to execute a telehealth strategy, including how to document and bill for those services.
  • “We’ve maybe found better ways of making sure we’re sending information in one format to everyone, so they all have that. I definitely see that we would make sure we’re sending that same message consistently going forward,” Evans stated.
  • “Even with the new off-cycle ICD-10 codes that came out or trying to provide training and education to everyone on those are the new E/M codes that went into effect in January for office visits. Things like that using the same types of format.”
  • But for those healthcare professionals and administrators who are reluctant to attend training sessions or may delete invites and emails before reading them thoroughly, technology can help.

Medical billing and coding services during pandemic did show hardest times for healthcare professionals, which indeed had both negative and positive impacts on the revenue cycle. Outsourcing companies were the major choice to get their work done successfully. So, choose the best for your future business commitments.

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