Revenue Cycle Management, ICD-10: Don’t code another chart until you understand these five rules
You are a medical coder or medical coding company. Let’s let it be a given that you know the CPT and ICD-10 codes and want to improve your efficiency, throughput, and accuracy. Let’s also assume you want to minimize risk to yourself and your medical coding company, while maximizing value and income!
- Streamline your workflow. As a medical coder or a medical coding manager, you will be dealing with a mountain of medical documentation and potentially other data relating to the patient visits you are coding. Depending on specialty this could be hundreds of pages of medical documentation per visit. It is imperative to have an organized, streamlined method of accessing visit documentation, ideally being able to find critical fields like PQRS, ICD-10 and CPT information, and efficiently coding through the visit.
- Quickly handle incomplete documentation. A coder cannot code a medical record if it is missing critical components, or if it is not signed and otherwise incomplete. Have a solid plan in place for communicating with your physicians, midlevel’s and other providers when you encounter an incomplete chart. Then have a solid way in your workflow to put that aside and move onto another chart while waiting for the deficiency to be corrected.
- Organize your work. If you can organize your work by the facility, by the provider, by insurance carrier, etc. – you will be better able to avoid “switching cost”. Switching cost, in this context, refers to the mental cost of changing from one type of work to another midstream. You have to reorganize your thought and pattern processes to the new work. Avoid switching costs by grouping your work into “like” queues or piles, and working through each queue before moving onto the next
- An audit is a must. Every medical coder is subject to making a mistake, or missing a detail. Plan to review the work of medical coders to look for issues BEFORE they get sent to a billing or clearing house system. It is much less costly to catch it now before it turns into a denial. You need to have a system of pulling out some percentage of charts for audit. The percentage may run from 1 to 100 percent depending on factors such as experience level, risk, PQRS, ICD-10, CPT, insurance types, etc. Use an audit process to educate medical coders so that mistakes are not repeated. Keep track of all audit outcomes to be used for training, evaluation, and improvement tracking.
- Understand your bottlenecks. Artificial and real bottlenecks will happen in revenue cycle management workflows. These may be tied to delays in obtaining physician documentation to be coded, or to difficulty in performing particular types of medical coding, or any number of factors. Coding a one-page anesthesia visit is much simpler than coding a 260-page hospitalist medicine visit. You must plan your medical coding workforce, and price your services, accordingly. Being able to set reachable goals for your coding clients will help you and them.