Revenue cycle assessment elements: Coding
When most people consider the elements of a revenue cycle assessment, they think of things such as copay collection, denial rates, and bad debt percentages; but the incorporation of a coding review can be just as important to the health of your revenue cycle.
Below are a few items to consider when integrating coding as a part of your revenue cycle review:
- Who completes the coding for your practice: physicians, coders, or a combination of both?
o There is no one panacea for all practices, but it is important to review the coding operation for your practice and its effects downstream in the cycle
- What types of coding denials are you receiving?
o This information helps focus the review on the specific areas of coding that may need enhancement
- Do you utilize a claims/coding scrubber? Can/do you build custom edits to comply with payer guidelines?
o This goes hand in hand with the previous question. If a coding scrubber is utilized and coding denials are still coming through, there may be enhancements needed to the edits currently in place
- What is the internal feedback loop to physicians and coders for coding related denials? Is it timely and actionable?
o If there is no feedback, or it is not detailed enough to provide the needed education and improvements, the same denials will likely continue unnecessarily
- Is there an independent coding audit performed at established intervals to verify coding compliance?
o Having a ‘second look’ at coding based on the auditor’s previous experience with other clients and payers can bring an added element of education and compliance that may not otherwise be possible.
By including coding as an integral part of your revenue cycle review; you can increase revenue, efficiency, and compliance while decreasing denials and expenses: all desired components of a successful revenue cycle review.