Optimize Medical Coding and BillingAs you wrap up an eventful 2016, you need to prepare your medical practice for the changes in store for 2017. For one, there will be 75,625 ICD-10-PCS codes for the fiscal year (FY) 2017, of which 3,651 are new codes and 487 are revised. There are also many CPT coding changes slated for the coming year. Here are some proactive strategies to optimize your documentation and medical billing and coding for success in revenue cycle management.

  • Ensure specificity in documentation for coding accuracy: Most providers now rely on outsourced medical coding services, but even the most experienced team can ensure accuracy only if documentation meets current requirements. In other words, the increased specificity of ICD-10 and rules of value-based models of care call for more detailed documentation of medical services. Physicians need to master the techniques of using electronic health records to capture clinical information in a comprehensive way.
  • Understand the implications of MACRA: The Medicare Access and CHIP Reauthorization Act (MACRA), 2015 will shift reimbursement from fee-for-service to pay for quality and value of services. Physicians need to understand the impact that this legislation will have on documentation, coding and reimbursement and which will differ by specialty. Practice income can be increased by evaluating all the measures for which data is reported, and selecting and reporting metrics in high performance areas.
  • Know the key metrics in revenue cycle management (RCM): The five key metrics in RCM are: Days in Accounts Receivable (AR), Days in (AR) greater than 120 days, Adjusted Collection Rate, Denial Rate, and Average Reimbursement Rate. Of these, the denial rate or the percentage of claims that payers denied is a key marker of how effective your coding and billing practices are. In February 2016, Revenue Intelligence reported that the ICD-10 claim denial rate were low and at a minimum among most hospitals and healthcare providers. However, denial rates could escalate if payers develop “more aggressive medical necessity models”, says a Medical Economics report. The end of the earlier grace period on unspecified ICD-10 codes by the Centers for Medicare and Medicaid Services (CMS) is an example of a more aggressive approach.
  • Improve time and resource management: Equip your staff to perform their tasks more effectively and inform them about new standards and expectations. Assign patient benefit verification to an insurance verification specialist. Delegating functions such as patient education and data collection to well-trained assistants can help you save time and make better use of your resources.
  • Revamp your medical billing and coding practices: If you do medical billing and coding in-house, see that your staff updates their knowledge and skills. Physicians who rely on medical billing and coding companies need to work as a team with them to enhance revenue cycle management. In fact, outsourcing is proving to be a practical option to drive improvements in coding and reimbursement in the current dynamic scenario.

The bottom line: monitoring the health of your practice is just as important as caring for your patients. A proactive team-based approach can help you better achieve both these goals.