Medical Coding in Healthcare BPO

Role of Medical Coding in Healthcare BPO

Have you ever faced consequences for entering a false medical code? It isn’t that simple to enter accurate medical coding for the processes as the medical codes keep changing frequently. But Healthcare BPO can be an expert to deal with it.

What is Medical Coding?

  • Medical coding can be a critical process in which the covered patient’s history, diagnosis, prescription and procedures are transmitted into medical codes.
  • Medical Codes are primarily classified into three types. They are
  1. CPT ( Current Procedural Terminology)
  2. ICD ( International Classification of Diseases)
  3. HCPCS ( Healthcare Common Procedure Coding System)
  • CPT is a standard medical coding procedure for U.S
  • ICD is set of medical codes published by World Health Organization (WHO).
  • HCPCS is another medical code developed by the Centres For Medicare and Medicaid.
  • Usually ICD codes focus on the diagnosis of the patient, CPT identifies the provided services to the patient and are frequently used by the payers to count on providers’ payment.

Healthcare BPO and Medical Coding:

  • Many healthcare professionals are expressing their keen interest in revenue cycle management and Healthcare BPO companies due to demand for value based care and best revenue payments.
  • Revenue Cycle Management process is mainly of Patient’s eligibility, Medical coding, Charge entry, Claim submission, Reimbursement, Account Receivable and Post payment.
  • Medical coding is crucial of all the steps involved in revenue cycle management process.
  • Most of the denials in the claim submission is caused due to invalid codes.
  • When the medical code is inaccurate, it fails to provide the complete medical history of the patient.
  • These medical codes are the basis for medical billing process and insurance claims.
  • The claims submitted to the insurance companies are based on medical codes to receive the payments on time for the services provided by the healthcare professionals.
  • Accurate medical coding brings less chances for claim denials and rejections by increasing revenue growth and strengthening the revenue cycle management process.

Challenges in Medical Coding:

  • There is no doubt that medical coding is a challenging and complex task.
  • It requires expert medical coding teams who are capable of analyzing medical reports and apply the codes without mistakes or errors.
  • The important challenges in medical coding are:
  1. Over Coding and Under Coding
  2. Lost Procedures
  3. Inaccurate Codes

1.Over Coding and Under Coding:

  • These are considered as the most common errors in healthcare BPO industry which indeed can result in loss of revenue payments or reimbursements.
  • Over coding is claiming for more than what has been served to the patient by the provider.
  • The two forms of over coding involves upcoming and unbundling.
  • Over coding is actually considered as fraudulent and also results in financial and legal penalties.
  • Under coding refers to the services those are not fully covered to the scope of work provided by the healthcare professionals.
  • This could bring a huge loss to the healthcare providers as well as results in lower reimbursement.

2.Lost Procedures:

  • These can occur where patients with certain conditions visits healthcare but might have diagnosed with a list of health issues and treatment provided.
  • Generally these are listed at the end of the report.
  • Coders occasionally will miss reading the full report and miss the ailments and treatments provided.
  • Some instances would be where the healthcare provider has missed to include the ailments and treatment provided.
  • The consequences that all these can result are only one thing and that’s revenue loss.

3.Inaccurate Codes:

  • Healthcare BPO has a group of experts who can handle medical coding without any complications.
  • Even then the common mistake among most of the medical coders is memorizing the medical codes over a period of time.
  • Coding from the memory allows the coder to stop referring and reading medical record and cause the tendency to miss certain ailments that the healthcare providers diagnosed or mentioned in the report at the bottom.
  • There are certain cases where the coders lose or fail to link ICD and CPT codes which can lead to denials and rejections, moreover huge revenue loss.
  • Medical codes do not remain constant. They change after a period of time. The numbers of medical codes seen are increasing by making the task more complicated.
  • These will have a huge impact on claim submission and payment clearance.
  • Healthcare BPO has to maintain a dynamic growth and succeed by providing satisfactory services to healthcare professionals as there’s a need to adopt set of uniform medical codes.
  • This would help to connect with healthcare providers easily and help facilitate with best services.

What Does a Medical Coder do?

  • Medical coders are the experts who take the responsibility to translate medical reports into medical codes.
  • They work behind the scenes by ensuring all the information is accurately coded.
  • After the examination, the payer understands the further procedure to process the bill.
  • Set of medical codes published to define medical procedures has a role to pass the information in a way it’s efficient.
  • Medical coder work anywhere that provides healthcare services including healthcare BPO. It also includes hospitals, clinics, nursing homes, RCM companies etc.
  • Some insurance payers also hire medical coders to handle certain patient claims by verifying the accuracy of the claims.
  • Medical coders has strong ethical standard as the patient data they work is highly confidential.
  • They are also keen in observing the reports in detail, as even a small error could bring a huge loss of revenue.
  • So, they remain focused as their work is extremely important and critical.
  • The important technical skills required for a medical coder are:
  1. CPT coding
  2. ICD-10
  3. Customer Billing
  4. Healthcare Information Technology
  5. Inpatient coding
  6. Outpatient coding
  7. ICD-9
  8. HCPCS coding
  9. Anatomy
  10. Clinical Documentation.

What makes Medical coding unique?

  • As mentioned medical coding in healthcare bpo is a process where diagnostic procedures are displayed as universal code numbers.
  • Medical coding provides and allows healthcare organizations and facilities to interchange healthcare systems effectively.
  • The pairing of codes with the healthcare organization’s data is what makes it unique and powerful as well.
  • It’s important to know the coding technologies as it helps to build a bond between structural data analysis and clinical records.
  • There’s so much data generated everyday, analytic systems require normal codes to perform much of its work in a sensible way.
  • Medical coders work in many types of healthcare related systems and not in healthcare organizations or hospitals.

Hope you have got the information about Medical coding and coders. If there are any suggestions regarding the blog post, do please comment below. For further queries and regular updates on healthcare, please subscribe to our blog.

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