Learn five questions you should ask your billing department or medical billing partner to ensure cleaner claims, maximum reimbursement, and lower compliance risk.
Medical coding consists of transforming healthcare diagnoses, procedures, medical services, and equipment into universal alphanumeric codes. Coding is one of the most critical components of the medical billing process. Therefore, this process must not be overlooked when ensuring healthcare providers collect all the money due for services delivered.
Whether your coding services are in-house or outsourced, your coding team should prove outstanding coding capabilities. This can help you achieve successful financial outcomes for your practice. If you outsource your coding processes, it can help you:
- Get cleaner claims.
- Obtain maximum reimbursement.
- Enhance revenue.
- Decrease compliance risk.
Unfortunately, many providers fail to investigate medical coding capabilities before partnering with a medical billing company.
Here is a list of coding questions you can ask your billing department or current medical billing partner:
1. Are your coders certified? Do they have the specific certifications associated with your specialty?
Coders should have the necessary credentials for the job but also have credentials specific to their area of practice. They should also prove extensive and relevant expertise and depth of knowledge required to handle the complex coding process. Coders should also keep up with industry updates, changes, and ongoing training, including annual ICD-10 and CPT updates.
2. What is the process when dealing with medical coding-related denials?
Coding denials should be tracked and trended to identify systemic areas of concern. Quantification and trending of these denials are the best ways to ensure you identify and address root causes to fix problems and prevent them from reoccurring. Regarding claim denials, fast and thorough follow-through is essential to ensure each valid claim is reimbursed for your practice.
3. How often do you audit your practice’s documentation for compliance?
To remain compliant, your billing department or medical billing partner must know the relationship between documentation and coding. For this reason, ongoing oversight and audit of documentation are essential. At Health Prime, we suggest doing a format audit at least once a year to monitor trends, give feedback to providers, and understand any issues that may arise and need to be addressed.
4. What actions do medical coders take if a payment comes in lower than the current fee schedule due to coding discrepancies?
Your billers or medical billing partner must know current contracts and fee schedules to ensure you get paid the proper amount for your services. Your coding team needs to have a system in place to track payments against contractual amounts. Otherwise, these underpayments will not be flagged and may get inappropriately transferred to patients or written off as bad debt.
5. Does your coding team utilize leading-edge technology and automated workflows to assure full reimbursement?
The healthcare industry is rapidly evolving, and the coding process is no exception. One of the significant aspects of correctly billing for your practice is the ability to incorporate and use the latest technologies to your advantage. Workflow automation will also help deploy more human resources into meaningful tasks. It will also allow you to automate tedious processes, relieving your team from administrative burdens.
It is also essential to consider how quickly your coding team or medical billing partner can adapt to planned or sudden and unpredictable changes on the medical coding frontier.
For providers, time is money. Ask about their typical coding turnaround time (TAT). Ensure you have immediate access to coding specialists to answer your medical coding questions around issues that may arise.
At Health Prime, we are committed to exceeding your coding expectations. Our coders undergo robust training, education, and quarterly audits by Certified Professional Medical Auditors (CPMA). They are also CPC certified through AAPC or AHIMA and must maintain a 95% accuracy to remain on an account. Most of them are above 98.5%.
Learn more about improving your medical practice by outsourcing your coding processes. Reach out to us at [email protected]. Our team will set up a meeting to discuss how Health Prime can maximize your revenue by cutting costs, saving you time, and collecting more!
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