The Key to Optimizing the Revenue Cycle: Zero in on Education

Friday, June 19, 2020 | Nicole Knight

The rapid impact of the COVID-19 pandemic has and continues to be at the forefront of our daily program operations. As we continue to be faced with several issues related to operating margins, revenue collection and reimbursement, safety has been our biggest priority. Thinking about accurate coding, clinical documentation improvement and ongoing education efforts are not top of mind… but should it be?

In the healthcare world the “norm” brings continuous reimbursement updates and payer rule changes combined with ongoing regulatory coding audits. This makes it difficult to keep up to date with coding and billing requirements. Couple this with a public health emergency (PHE) that adds differing payer guidance, effective dates and “special” instructions and the importance of focusing on coding, billing and documentation efforts is even more critical.

In our fee for service world, physician services are reimbursed based on associated CPT® (Current Procedural Terminology) or the HCPCS (Healthcare Common Procedure Coding System) codes submitted on the claim forms, while the ICD-10 diagnosis codes establish the medical necessity for the service. With over 70,000 ICD-10 diagnosis codes and well over 10,000 CPT codes, it can be taxing to keep up without ongoing education.

A proactive plan to facilitate coding and documentation education will increase accuracy and quality as well as decrease claim denials. Providing ongoing education will empower your team with knowledge to get it right on the frontend, which is essential to cost per claim and timely reimbursement. Combining education with periodic audits can also help promote the professional growth and development of your coders and could pay dividends to your organization. With most organizations targeting a coding accuracy of at least 95%, it is important to remember this is a team sport and involve all stakeholders in communication and education efforts. Promoting collaboration and investing in your coders are keys to success.

How can we help?

Coding integrity is an integral part of the revenue cycle and should align with your organization’s overall strategic mission. Determining where there are initial gaps in the integrity of coding will you help decide where to focus efforts. As cardiology-specific coding experts, the MedAxiom Revenue Cycle Solutions team is the premier resource for cardiology coding. Our services can be tailored to meet any organization’s needs whether temporary or long-term, education and training, a simple phone call or a back-up coder. We’re here to help you educate your physicians and coders.

Learn more about the MedAxiom Consulting Team and how we can help you and your organization tackle issues such as revenue cycle management, patient access, staffing/operational efficiencies, adaptability and more.

Illustrator: Lee Sauer

About the Author
Nicole Knight

Nicole Knight, LPN, CPC, CCS-P, ACS-CA, is Vice President, Revenue Cycle Solutions and Consulting at MedAxiom. Her decades of hands-on health care experience includes cardiology and neurology practice operations, clinical management, business office management, and consulting for coding and compliance. Nicole maintains her LPN licensure in Louisiana and Florida. She is a member of the American Academy of Professional Coders and the American Health Information Management Association. She received her Advanced Coding Certification with the Board of Medical Specialty Coding. Nicole is a certified AHIMA ICD-10-CM Trainer and completed a Lean Sigma Healthcare training course at Johns Hopkins University. She also serves on the Physician Practice Council for AHIMA.

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