Medical Coding Best Practices to Improve Accuracy

Medical Coding Best Practices to Improve Accuracy

Concerning medical coding, accuracy is everything. Even the smallest error can lead to a huge loss. Coding requirements change often, and with denials totaling a big chunk of the amount per year, one can’t afford to risk under or over-coding, not to mention to rely on obsolete codes.

While certain difficulties with medical coding quality come because coders work from a distance, you can carry out some best practices to work on quality and guarantee accuracy whether coders are in-house or working from a distance.

Stay up-to-date with Coding Updates

Medical codes convert data about the patient’s medical services experience into an electronic format that payers use to settle claims for repayment. However, if a coder incorporates obsolete, missing, or incorrect codes, the claim is denied. Thus, it is important to stay up-to-date. 

With several constantly changing codable terms, medical coders continuously face challenges decreasing accuracy. Having updated in-depth knowledge of the important codes can serve the purpose.

Some of the important codes to stay updated with are:

  • Current Procedural Terminology (CPT) codes
  • Diagnosis-Related Group (DRG) codes
  • National Drug Code
  • Healthcare Common Procedure Coding System (HCPCS) codes
  • International Classification of Disease 10th edition (ICD-10) codes

Customize Claims Edits to Your Requirements

Usually, claims management software solutions apply updates using group edits or universal claims. But this activity does not provide accuracy in situations involving multiple combinations of the payer, geographical edits, and specialty. 

So, to improve accuracy, you can use software that possesses the feature of client-specific customized edits. It will allow you to track changes and capture the requirements of all repayment strategies that are relevant to a specific case.

Perform Coding Quality Audits

Internal Coding Quality Audits can identify aspects that are causing revenue leakage either because of a lack of training or workflow issues. This reveals repeating issues with under-and over-coding, utilization of repetitive and obsolete codes, non-compliance, and poor documentation.

Thus, it’s a good idea to undertake regular coding quality audits to remove any repetitive issues.

Note: For audits to be compelling, they ought to be done consistently.

Communicate Effectively with the Team

Coding quality reviews can uncover key ways of further developing medical coding quality and accuracy. In any case, without robust education and training programs set up, audit findings are of no use.

You should convey the findings and any changes in coding to coders at the earliest. Communicating the findings will empower coders to change work processes quickly to further develop coding quality. In addition, it guarantees coders are on the same page with updates to coding compliance.

Use AI to Enhance Medical Coding Accuracy

Manually matching every patient experience to a particular set of codes is tedious and vulnerable to errors. However, AI can improve the process by examining unstructured clinical diagrams and notes to attract data applicable to the case. It can also cross-reference various coding directories to select the appropriate code.

While a portion of the result produced by AI frameworks should be checked, it radically reduces the workload on staff and guarantees better accuracy. 

Medicodio is an AI-powered coding tool that reduces medical coding costs and improves efficiency by up to 45%. A great fit for RCM companies and hospital billing departments, Codio suggests medical codes (CPT, ICD10, HCPCS, modifiers) by reading patient demographic info from EHR systems and Physician Notes/Chart. After the medical coder makes a selection from the list of suggested codes, CODIO sends your codes to the billing system.


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