s the healthcare landscape has transitioned from a fee-for-service model to value-based care, there is a growing challenge of staying financially healthy. Various factors that impact a practice’s revenue. Healthcare organizations need to work in tandem with their medical billing and coding company in creating winning strategies that can accelerate reimbursement and revenues. Here’s a deep dive into some of the proven billing and coding strategies that optimize the revenue cycle performance and drive up an organization’s financial health of an organization.
Medical coding compliance is a significant part of healthcare Revenue Cycle Management ensuring critical patient data security and privacy while preventing audits and revenue leaks.
Using Correct CPT (Current Procedural Terminology) and International Classification of Diseases (ICD-10) codes help get maximum reimbursements for Evaluation/Management (E/M) and office visits.
Modifiers in combination with CPT and Healthcare Common Procedure Coding System (HCPCS) can be used to notify insurers of possible special circumstances. Errors in modifiers can have the ripple effect of causing billing errors and claim denials that disrupt the overall revenue cycle. Medical billing service companies are equipped with well-trained and certified coders and help prevent coding errors using the right modifiers.
The sudden spike in telemedicine solutions adoption due to the global pandemic has enhanced patient access and elevated patient satisfaction scores. However, reimbursements could be a challenge for remote healthcare services, and healthcare organizations need to stay tuned to the latest CMS updates and redefine strategies to improve telemedicine reimbursements. Coders need to use the Place of service code 02 to report telemedicine services offered from a remote site. Insurers may also need modifier -95 when remote healthcare services are delivered through synchronous patient-provider communication.
Claims submitted within 30 days of discharge for the same patients are most likely to be rejected by payers. This is one of the key reasons hospitals and practices integrate digital patient engagement solutions to reduce readmissions and maximize health outcomes. Practices also need to collaborate with the specialists to figure out who might be billing for the CCM and submit claims at the right time.
TCM is yet another area with higher denial rates. To avoid TCM denials, care coordinators need to reach out to the patients discharged and have an interactive conversation with them (phone, in-person) within two days to get accurate information. Proper documentation of Admission Discharge Transfer (ADT) feeds, discharge summaries and seamless integration of data into the EHR management are also critical factors. This will facilitate the admin staff to engage with patients in an outpatient setting quickly. The more detailed the documentation, the lower the denial rates, so ensure that you equip the payer with accurate and detailed documentation—starting from the data of discharge, date of the call, summary of interaction and more essential details especially in case of high-complexity TCM scenarios.
Eligibility verification and pre-authorization are some of the checklists you need to verify to evaluate insurance coverage and patient responsibilities prior to the appointment. Failing to verify these insurance related details prior to patient visit could lead to unnecessary frustrations in terms of delayed or denied claims, reduced patient satisfaction as well as nonpayment.
Healthcare revenue cycle management companies can help with timely and detailed reports and analysis. However, clinicians need to decode and comprehend these reports to make the right business decisions. Physicians need to keep track of these critical insights.
Claim denials can happen due to a seemingly smallest error—like a spelling mistake or minor other mistakes that could easily be overlooked. Healthcare organizations need to ensure that accurate details are filled out in the relevant fields.
The pandemic scenario has given rise to frequent coding updates. Hence, Care providers need to be well-equipped with these updates to stay on top of the medical billing and coding process. Partnering with an efficient healthcare revenue cycle management company can give you the winning edge by helping you take advantage of the latest billing software, industry best practices and accurate billing and coding handled by certified and experienced coders. To learn more on how SolvEdge Medical billing and coding specialists can help transform your revenue cycle, give us a shout.
