Can you guess what stands as a backbone for revenue cycle management companies and healthcare professionals to expand their business relentlessly? Okay! It’s none other than medical billing and coding processes.
As revenue cycle management companies offer medical billing and coding services, it translates the patient’s encounter into language for claim submissions and revenue payments.
Of course, medical billing and coding processes are totally different, yet crucial for revenue reimbursements for the services rendered by healthcare professionals. They follow their own originality to convert the billing process into revenue payments by mostly avoiding or preventing claim denials.
When medical billing uses codes for claim process and patient billing, medical coding in revenue cycle management companies extracts the reliable billing information from the clinical documentation and medical records.
Medical Coding in detail:
- Medical coding process kick starts with the patient’s encounter with the healthcare professionals, while they enter the diagnosis procedures and service rendered to the patient with clear specifications in the medical record.
- It’s very critical to enter and submit accurate clinical documentation while patients encounter medical billing and coding processes.
- The most important rule in healthcare billing is, not to bill or code for the procedures that’s not documented properly in the medical records.
- Revenue cycle management companies uses healthcare professionals clinical documentation while claiming reimbursements with insurance companies during conflicts with a claim occurs.
- If the services aren’t properly documented, the healthcare professionals and revenue cycle management companies could face denials and revenue loss.
- Once when a patient is discharged from the hospital, the clinical documentation is handed over to medical coding department from revenue cycle management companies in order to review and connect these services with codes related to the diagnosis, procedures, charge and facility codes.
- The different types of codes used in medical coding for submitting a claim to the insurance companies are various. Some of them include:
ICD-10 Diagnosis Codes:
- Diagnosis codes play as a key to describe the complete patient status and also the social determinants of patient’s health and other conditions.
- Healthcare industry has set International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) in order to capture diagnosis codes for medical billing process.
- Normally, ICD-10 codes has two sets of components, which are ICD-10-CM known as Clinical Modification and the latter is ICD-10-PCS known as Procedure coding system for the inpatient procedures performed in healthcare organizations.
- As per record, there are more than 70,000 unique identifiers in only ICD-10-CM code.
- These codes indicate and reveal the patient’s condition and injury when visited to initial encounter with healthcare professional.
CPT and HCPCS Procedure codes:
- Here, the procedure codes compliment those diagnosis codes indicating the procedure performed during patient encounter with the healthcare professionals.
- It has two vital procedure coding systems. Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System ( HCPCS).
- The American Medical Association actually presents and publishes CPT coding guidelines every year in support to medical coding teams of revenue cycle management companies with coding specifications and procedures.
- So, it’s evident for medical coders to beware of CPT codes along with its modifiers that explains diagnosis and procedures in great detail.
- CPT modifiers is to indicate if healthcare professionals has performed multiple procedures and the necessity for the service accompanied with the procedure performed on the part of patient body.
- CPT modifiers also ensures if healthcare professionals or the revenue cycle management companies are reimbursed accurately for all the services rendered to the patient.
- When private insurance companies usually have the tendency to use CPT coding , CMS and revenue cycle management companies submit their claims with HCPCS codes.
- HIPAA encourages the use of HCPCS codes which accompany CPT coding system.
- At times HCPCS and CPT codes overlap. However, HCPCS codes are able to different and describe non physician services like ambulance rides, equipment use, prescribed usage of drugs. CPT do not support non physician services as mentioned above.
- HCPCS codes also contain modifiers which are very similar to CPT coding modifiers and are used by CPT coding system.
Codes for Charge Capture:
- Medical coders in revenue cycle management companies connect and match healthcare providers order entries, patient’s services and clinical services using charge entry.
- Charge entry is the price allotted according to the services provided by healthcare organizations elaborating each and every service keenly.
- The above process is called as Charge Capture. Revenue cycle management companies will use charge capture to negotiate claims with the insurance companies and bill for remaining balance.
Facility and Professional Codes:
- The duty of medical coders is to translate medical records to professional and facility codes.
- Professional codes actually captures healthcare professional’s and clinical services to connect with particular codes for medical billing process. These codes are connected through documentation in medical record of patient.
- On the other side, the facility codes are mainly used by healthcare organizations and hospitals to charge for the cost of services provided . These codes include the charges for space, equipment, supplies, prescription of drugs and other technical patient care.
- Hospitals at times also include professional codes if necessary on claims when healthcare providers perform services for the clinical procedures.
- But facility codes can’t be used if healthcare providers are under contract and renders services and codes of hospital spaces and supplies.
- It is considered that the finest practice for the healthcare organizations is to combine facility and professional coding together.
- Integrated professional and facility coding practices results in clean claim rate and increase in revenue reimbursements and coding productivity.
Traits of a Professional Medical Coder
The demand for professional medical coders is predicted to increase by 9% from 2020 to 2030, according to the reports of the Bureau of Labor Statistics. While coding certifications are not a mandate to employ a coder in your organization, the rigorous examinations taken previously by the professional surely add credibility to their work. If you want to engage your organization with a valuable team of coders, check out the professional training certifications that might help you.
There are several certification programs offered by the American Academy of Professional Coders (AAPC) and other organizations. The most common ones taken up by the professionals are Certified Medical Coder (CMC), Certified Coding Specialist (CCS) and Certified Professional Coder (CPC).
For healthcare specialty organizations, it is crucial to have professionals who are abreast with the latest modifications of the particular specialty. Healthcare organizations often search for coders with specialty certifications to be a good fit for this role. Some of them are:
- Certified Outpatient Coder
- Certified Inpatient Coder
- Certified Risk Adjustment Coder
- Certified Ambulatory Surgical Center Coder
- Certified Evaluation and Management Coder
- Certified Obstetrics Gynecology Coder
Apart from the ones mentioned above, you can also hire coders from other specialties. It is best to evaluate the needs of the particular organization before opting to equip your team. However, several healthcare organizations find it difficult to recruit and manage such a scrutinized team of coders in their in-house department. You can get in touch with revenue cycle management companies who have professional coders taking care of the job without having to invest your assets at once.
Hope you have got the information on medical coding in revenue cycle management companies and types of coding practices used in healthcare industry. For suggestions, please comment below. We will consider them if relevant to the blog. For more queries and updates on healthcare, please subscribe to our blog.
