Healthcare reimbursement can be a time-consuming, difficult, and frustrating process. Traditionally, the medical billing and coding processes that practices must complete in order to receive healthcare reimbursement have included numerous steps, any of which can easily be derailed. When these processes are performed manually (by manually keying claims), the risk of medical billing errors, low first-pass resolution rates, and time-consuming administrative tasks increases. While traditional on-paper billing and coding continue to play an important role in the medical reimbursement industry, best electronic health records (EHRs) have significantly reduced the administrative burden on practices. By maximizing resources, lowering error rates, and increasing efficiency, EHR can assist practices in streamlining their revenue cycle.
What Makes the Medical Billing And Coding Process So Difficult?
Medical coding is essential for avoiding denials, claim rejections, and proper reimbursement. Over the years, practice management software have released numerous features. To assist with things like provider documentation, code search, and claims scrubbing. EHRs with proper coding systems can help providers lower denial rates. By guiding them to the appropriate Current Procedural Terminology (CPT) codes, ICD-9/ICD-10 codes. Also with Health and Care Professionals Council (HCPC) standards, with over 69,000 ICD-10 codes alone.
Payers frequently have very specific parameters that must be met in order for them to accept a claim. And their expectations change frequently. Denied claims are a significant source of revenue loss for medical practices. Incorrect diagnosis and/or procedure codes. For example, will almost certainly result in a claim being denied entirely. Denied claims must then be reworked, which takes time and resources away from practices. Hospitals in the United States lose $262 billion per year due to claim denials or rejections, according to Modern Healthcare. If a hospital or practice is unable to secure a denied claim, they must find other ways to offset the costs. Rejections and denials are most commonly caused by:
- Claim form errors (between 40% and 80% of medical bills contain errors)
- Errors in the code
- Claim submission deadlines
Claim rejections (which do not always result in a permanent denial of payment) are frequently the result of simple clerical errors. To avoid rejection, everything in a claim must be correct and meet the insurer’s or payer’s requirements. Small errors, such as a misspelt patient’s name or transposed digits in an ID number, can result in rejections. While these errors are easily corrected, they do extend the revenue cycle and necessitate the rework of claims (which means more time and effort is spent and delays when the practice will receive reimbursement).
How can your EHR assist you with medical billing and coding?
When a patient encounter occurs, medical coding begins, and providers detail the visit or service in the patient’s EHR. With simple EHR software, providers can easily explain why they provided specific services, items, or procedures by using the appropriate codes. Many tasks that save physicians time and energy, such as electronic prescriptions and claim processing, are automated by EHR systems. Accurate and complete clinical documentation during the patient encounter is critical for successful medical billing and coding. E-health records assist providers and practices in organizing paperwork, reducing errors in patient care, and streamlining processes (e.g., cutting administrative costs). Medical billers and coders can then use the data from EHR systems to justify any financial reimbursement from insurance companies while keeping an accurate legal record of medical events.
Reduce Denial Management-EHR
EHRs with coding, denial management, and charge capture features can be critical to the success of your practice’s billing operations. Diagnosis codes, as well as social determinants of health and other patient characteristics, are critical in describing a patient’s condition or injury. No provider, however, can expect to know every code associated with every encounter off the top of their head. The ICD-10-CM (clinical modification) code set alone contains over 69,000 unique identifiers.
Manual medical billing is a major challenge for all sizes of provider organizations. Both medical billing and coding are essential components of the healthcare reimbursement system. When an EHR can save physicians time while also ensuring higher levels of accuracy, they can be confident that the medical billing and coding cycle is running as smoothly as possible.
Because the financial health of a practice is just as important as the quality of care provided, streamlining the revenue cycle allows providers to get paid for services delivered faster, and provider organizations to stay open while providing high-quality care to patients.
- Clinical Documentation Automation, More Accurate Coding, and More
- Improved ability to meet critical regulatory requirements (HIPAA, HCPCS, etc.)
- Time and resources required for manual charge entry are reduced (this means more accurate billing and minimizes the number of lost charges)
- Reduced vendor/insurance denials as a result of late filing
- Charge review edits inform physicians whether a test can only be performed at a certain frequency.
- Reduce claim denials and lost charges caused by incorrect CPT, ICD-9/ICD-10, or other coding.
How can a company avoid having claims denied?
Health care providers can reduce the number of denied claims by incorporating a claims denials prevention system into their revenue cycle management. The system can track denials and identify the underlying cause, amount denied, and physicians involved. This assists in determining denial rates and identifying patterns.
A useful denials prevention system entails not only technology. But also collaboration across relevant departments within an organization. Such as accounting, coding, case management, and compliance. Denials must be reviewed collaboratively, and process improvement efforts must be identified.
When your staff gathers information at the appropriate time, prior to providing healthcare services. To the patient, your practice will function more efficiently and effectively throughout the RCM. Furthermore, keeping a detailed patient record will help you understand the various health issues. And also concerns your patient has from the start of the revenue cycle.
Conclusion-EHR
Your EHR system is critical to streamlining your healthcare revenue cycle management strategies and ensuring that the process is accurate and results in appropriate payment. This technology will allow you to generate a consistent stream of revenue by:
- Keeping track of claims throughout their lifecycles
- Payment collection
- Taking care of claim denials.
Patient payments, reimbursement, and communication are all facilitated by the EHR. You can use your system to synchronize these aspects of the revenue cycle, allowing you to focus on providing high-quality care while maintaining your practice’s financial viability. Read updated blogs for more information.