Coding is the most crucial part of medical billing. Clam reimbursement heavily depends on coding perfection. Payers deny about 5% to 10% of insurance claims due to the application of wrong medical codes. The common errors include
- Incorrect procedure or diagnosis codes
- Missing or inconsistent modifiers
- Mismatched information between the diagnosis and the procedure performed etc
However, to avoid revenue loss due to coding denials healthcare providers must ensure their medical coders have a thorough coding conception. Moreover, medical coders are not easily available and employing them will be costly for providers. Additionally, the enhanced cost may affect their operational budget and revenue cycle as well. While outsourced medical coders come as a solution to many medical coding companies. The coders are equipped with the best knowledge and expertise in the healthcare industry. Hence, they can ensure the uttermost coding accuracy in a cost-effective way. Also, there are survey reporting that outsourced medical coding companies save about 80% of operational costs for providers.
Factors to Consider When Choosing Outsourced Medical Coding Companies
Selecting perfect outsourced coding team is a pretty intricate task. Providers must ensure the third-party coders are well versed and up to date with new codes, all the coding regulations, modifiers and helps in eradicate coding denials. In fact, here are the proven strategies to select an efficient third-party medical coding company.
Specialized Expertise
Providers must check the coding accuracy of outsourced services. Accuracy should be 95% or higher. Moreover, providers must check out the reviews of previous companies they have worked with. It will enable providers to understand their professionalism, expertise, and accuracy level. Also, they must look for robust auditing and feedback processes to maintain high standards.
In-depth Coding Knowledge
The outsourced coders must have in-depth knowledge and understanding of all and every code. Do you know proper application of ICD-10, CPT, HCPCS, and revenue codes along with modifiers is extremely important here? Furthermore a coder needs to be updated always. Moreover, when choosing the right RCM professional for your practice, a provider should further check whether the outsourced coders have CPC (Certified Professional Coder) or CCS (Certified Coding Specialist) certification. It will ensure optimal expertise and coding perfection.
Compliance with Regulations
The medical landscape in the US is filled with regulatory compliances. Healthcare authorities like HHS, AMA, etc. frequently introduce new regulations. As being non-compliance with these regulations can only result in coding denials and delayed reimbursement. Hence, providers must ensure the outsourced coders are up to date with current coding guidelines and regulations. This way, they can eradicate coding denials and maintain a healthy revenue cycle.
Revenue Cycle Management (RCM)
The outsourced agency must offer a full suite of RCM services. They must look after billing, coding, and collections to ensure seamless cash flow. This way, providers can take a budget-friendly approach. It will reduce their overall operational costs, and they can benefit from healthy cash flow.
Successful Prior Authorization
Prior authorization is one of the most crucial steps in medical claim processing. Providers must approve the treatment and medication costs from the payer before rendering treatment. It requires the application of proper medical codes to represent the necessary treatment plan, medication, and services. Providers must check the prior authorization success rate before choosing third-party medical coders.
Responsiveness and Communication
The outsourced medical coders must pay extra attention to detail to ensure optimal coding perfection. They must be available round-the-clock and solve any issues at the earliest possible. Seamless communication will ensure providers and outsourced coders are on the same page and together they can swiftly address any concern.
Benefits of Employing Outsourced Medical Coding Companies
Medical coding adds a significant administrative burden on the in-house staff of providers. It affects their overall functionality. Outsourcing medical coding notably reduces their workload. Moreover, employing full-time in-house coders will be costly. It will further increase the provider's operational costs. Alternatively, outsourced medical coding companies are pretty cost-effective.
As mentioned, employing outsourced medical coders will reduce approximately 80% of operational costs for healthcare providers. Also, when outsourced coders take care of the most administrative burden, in-house staff can concentrate their entire focus on patient care. It will ensure increased coding efficiency and better patient outcomes at a reduced cost.
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