What is medical coding?

 

 

The revenue cycle is critical for every healthcare entity, and submitting the correct medical coding for every procedure performed is the first step in effective revenue cycle management.

Collaborative Imaging allows you to maximize revenue at all levels of the cycle with our revenue cycle experts and cutting-edge technology. It all begins with accurate medical coding.

What is medical coding?

Medical coding is an alphanumeric shorthand used by all healthcare entities to document every aspect of each patient’s care — from the patient’s diagnosis to procedures and treatments, services, and supplies.

Medical coding is not only essential in patient care but also revenue management. Medical coding benefits individual patients and healthcare organizations and advances overall health in the U.S. Data gathered from these codes helps establish utilization, evaluate health risks, create actuary tables, and monitor public health risks.

There are six HIPAA-mandated code sets; however, only three are commonly used in the U.S.

1. The International Classification of Diseases, created by the World Health Organization (WHO) in the 1940s, contains codes for conditions and activities that cause death, injury, or illness. The ICD is regularly updated — we are now in the 11^th edition since its inception. The ICD codes help establish the medical necessity for services.
2. The Current Procedure Terminology code documents patients’ medical procedures at their clinical visits. The American Medical Association owns and maintains the CPT, which is updated quarterly. There are three categories:
3. Specific medical specialty — radiology, surgery, or other fields
4. Performance measurements — including potential laboratory and radiology results
5. Emerging technology — new procedures, vaccines, and technology
6. The Healthcare Common Procedure Coding System is the official coding for Medicare and Medicaid, and it’s also used for outpatient surgery billing and quality measure tracking.

Why Outsource Medical Coding?

Medical billing and coding are the foundation of healthcare’s revenue cycle. When the coding is accurate and performed on a timely basis, medical coding fulfills the goal of on-time and accurate reimbursement for the procedures, services, and supplies utilized in patient care.

Unfortunately, events don’t always happen as planned. What happens when your practice can’t hire a competent medical coder, or your medical coder makes many mistakes that result in a loss of revenue? There are thousands of codes, and a one-digit or one-letter mistake can cost your practice hundreds or even thousands of dollars. Even worse, an incorrect code may be construed as billing for a service not rendered, resulting in delayed payment or, hypothetically, fraud charges. Post-pandemic staffs are already overwhelmed, so outsourcing your medical coding could be one of the most practical decisions you could make.

Although it may seem counter-intuitive, outsourcing your practice’s medical coding may be financially beneficial — saving administrative costs, improving cash flow, and possibly increasing revenue.

7 Reasons to Outsource Medical Coding

Every practice faces different challenges, but you’ll quickly see that these 7 reasons are compelling enough to consider outsourcing seriously.

1. Hiring Challenges. Pandemic-created challenges, including children at home or caregiving for older parents, made retaining and hiring medical coders much more difficult, and there is a shortage of qualified medical coders. According to Zippia, there are about 118,000 medical coders, and their average age is 46.
2. Maintain Staffing Levels. You’ll no longer worry about recruiting and hiring a new coder when your practice volume increases. The hiring process takes a long time, and your new coder may not be familiar with radiology coding. Outsourcing provides access to a qualified pool of coders, so there’s no delay in submitting claims.
3. More Time for Practice Management. Many physicians take care of coding themselves. Yet they lose valuable time in revenue-enhancing activities. Outsourcing to a respected organization ensures accurate coding and faster collections while providing more time for the core activities of your practice.
4. Compliance and Security. Providing protection again data breaches and data recovery should a breach occur are part of what every radiology practice must do to comply with HIPPA requirements. Collaborative Imaging achieved SOC 2 certification to protect your patients’ privacy and your practice.
5. Increased Accuracy and Timeliness. Access to a pool of coders ensures accurate coding for every procedure, even when you experience a surge in volume. Yet you won’t have a coder sitting idle because of an unexpected slowdown in volume.
6. Scalability as Practice Grows. You’ll never have to worry when your practice grows about hiring more coders. Ci’s medical coding solution provides access to specialized coders with varying certifications. If you begin serving a new hospital, our medical coding option provides HIPAA-compliant coding that meets your growing practice’s needs.
7. Data Analytics. Collaborative Imaging’s medical coding support includes data analytics to help your practices have a clearer picture of its practice’s profit centers. You may also discover procedures that aren’t a good fit for your practice.

Ci’s medical coding support from certified, HIPAA-compliant coding specialists seamlessly integrates into your daily workflow. Contact us to learn more.