1. Introduction: The problems surrounding Revenue
Revenue goals across many hospitals in the US remain unmet due to staffing issues, claims’ denials, inability to access updated information, lack of uniformity, inflation amongst other reasons for cost of medical coding.
This results in significant loss of income for your healthcare practice. In response, various hospital executives are questioning how they can maintain a steady cash flow and preserve revenue.
Despite this, many practices still lean towards in-house cost of medical coding, not realizing just how much it is costing them.
2. Assessing in-house expenses for cost of medical coding
Is reducing administrative and operational costs on your mind? Then it’s time to take a long, hard look at the costs related to in-house coding.
The efficiency of your cost of medical coding framework is critical to maintaining a steady flow of revenue and improving your bottom line. However, this is easier said than done. The coding landscape is a constantly evolving one, with countless changes to existing protocols along with the addition of new ones.
This necessitates additional investment and constant training for coding professionals to ensure that they remain abreast with the evolving federal and state requirements.
- Cost of medical coding for employing and training professionals
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This cost can vary both depending on the size of your practice and whether your coders are certified or uncertified.
According to AAPC, the average salary of a medical coder is $52,411 annually. Moreover, a certified coder with specialized skills will command an even higher salary. Add to this, other expenses, and benefits such as health insurance, and your costs keep increasing.
- Non-financial aspects of hiring coding professionals
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Cost is not the only consideration when it comes to in-house coding. The current shortage of qualified medical professionals, due to the implementation of IDC 10, exemplifies how it can become a hassle to be dealt with by billing and coding experts.
- Silent expenses
Another cost that organizations often fail to acknowledge is recurring required costs such as the space occupied by your cost of medical coding team and the cost of amenities such as telephones, internet, and electricity. Seemingly trivial, these do accumulate to represent a significant amount that could be otherwise saved.
3. The tasks performed by coders
Conventionally, coders were required to read and analyze the medical charts of patients to which services have been provided. Accordingly, the diagnoses and procedures are categorized by them in numeric or alphanumeric codes. However, the responsibility of professional coders today has expanded to include:
- Conducting audits and internal review
- Connecting with physicians for additional information/
- Undertaking activities related to compliance
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- Specific billing-related tasks
- Filing claims
- Appealing denied claims
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In short, the profession of a coder includes a wide range of multi-faceted responsibilities – meaning training can be a huge undertaking.
4. The risk of denials – Cause and cost of denials
The root cause of denied claims lies in incorrect and inadequate cost of medical coding, understandably a serious barrier to revenue generation. The three primary coding errors include duplicate/ unbundled services, incorrect modifiers, and missing information.
Change Healthcare found that a typical health system could lose approximately 3.3% of net patient revenue, an average of $4.5 million per hospital. This is despite the fact that 63% of the denials were actually reworkable. Nevertheless, this can cost providers $118 per claim on appeals. The statistics speak for themselves, in-house coding is an expensive and time-consuming process.
While there are obvious financial benefits of in-house coding, the benefits of outsourcing your cost of medical coding practice are not limited to merely financial gains.
5. Other benefits of outsourcing your coding.
1. Up-to-date certification
Medical coders must be continually learning and familiar with updates to the coding system, regulatory guidelines, and best practices. This warrants a significant amount of time invested. Partnering with a third-party medical coding specialist means that this is no longer the responsibility of a practice. You can focus on your core activities knowing that certified coders are vigilantly working on your charts. It also helps you to ensures that you don’t lose money because you weren’t aware that you could get paid for a service you provide.
2. Consistent staffing level
Let’s say that you have a team of coders, and you rely on them for all your cost of medical coding needs. But do you also have the bandwidth to accommodate changing conditions? Who do you turn to when the volume and cost of medical coding that needs to be addressed exceeds the existing capacity of your team? Or the times when you are short-staffed due to a myriad of reasons? Aren’t we all too familiar with the consequences – backlogs and delayed payments which in turn leads to disruption in revenue.
3. Hiring challenges
It is becoming increasingly difficult to hire coding professionals due to persisting shortages to reduce cost of medical coding. Even trickier is finding a coder who is experienced in a particular specialty. Furthermore, the shortage of coding professionals has driven up the salary levels across the industry. The bigger picture shows that hiring and retaining a coder is not an easy task for a healthcare practice and can detract from performing core-activities. On the other hand, a reliable partner ensures that you always have a pool of coders with different specialties available to take your work further.
4. More time for core activities
As a healthcare organization, you should not have to be burdened by the complexities of revenue cycle management. There is a considerable opportunity cost when you choose to do your coding in-house. As you embrace outsourcing, you will realize just how much it took away from your practice. Be assured of accurate coding and timely compensation, without having to take time away from your core practice.
5. Transparency
Your coding partner will be able to provide you with detailed reports and performance records relating to your billing and coding. Access to precise organized data and analytics will give you insight into how your practice operates and empower you to make informed decisions.
6. Security and Compliance
Security and compliance with regulations is a non-negotiable aspect of any healthcare organization. Ensuring that the required compliances are met takes a lot of effort. Moreover, it has become increasingly important to remain vigilant regarding insidious cyber-attacks. This calls for meticulous attention to compliance and robust security measures to protect against untoward incidents. A professional partner has tools at its disposal and cutting-edge technology to safeguard the interests of your practice.
Choosing to outsource your medical coding is an important decision to reduce your cost of medical coding. If it’s one you decide to make, EMPClaims offers an entire range of services to help you access an entire team of experienced medical coders.