Medical billing and coding services will become more complex every year as a result of several factors, including the introduction of new payer policies, continuing evolution of rules, and increased restrictions for audits that are likely to increase the risk of rejection, penalty, and reduction in revenue. Having strong medical billing and coding services in place is critical to protect revenue, ensure compliance, and avoid costly disruption. The following list contains the primary strategies that should be addressed by healthcare organizations.
Keep an Eye on Regulatory Changes
Healthcare regulations are changing all the time; CPT codes, ICD-10 codes, and HCPCS codes are updated on an annual basis, and payer-specific billing policies change more often. Therefore, in order to remain compliant with regulatory requirements:
- Â Stay current with CMS updates and payer bulletins.
- Â Review annual code changes and updates to coding guidelines.
- Â Subscribe to professional coding associations and regulatory alerts.
- Â Perform quarterly internal compliance valuations.
Provide Your Staff With Continuous Training
Even the most well-trained and experienced billing teams need to receive continuous education and ongoing training. Coding rules, documentation requirements, and payer policies are constantly changing and evolving, and cannot be fully understood through outdated training and knowledge. Some of the best practices for ensuring ongoing education and training for your staff include:
- Â Conduct regular education and training sessions for billers and coders.
- Â Offer certification programs for billers and coders.
- Â Annually assess the competency of your coding staff.Â
Having properly trained medical billing personnel is one of the most important lines of defense against compliance issues.
Improving Clinical Documentation Practices
In order for coding to be accurate, you must have correct clinical documentation. If clinical documentation is incomplete or unclear, the provider may be subject to potential denials of claims, audits, or even upcoding or undercoding allegations. Providers can generate accurate coding and reduce compliance risks with the help of the following practices:
- Â Use standard documentation templates.
- Â Ensure that the clinical documentation supports the medical necessity of the service being provided.
- Â Educate clinicians on the documentation requirements associated with coding (i.e., items like medical necessity).
- Â Implement a system of regular audits of clinical documentation or a system for providing feedback on clinical documentation.
Maintaining proper clinical documentation will ensure that coding will be completed accurately.
Employ Technology and Automated Compliance Solutions
With manual coding and billing processes, there is a much greater chance that errors will occur. A growing trend among the best medical billing companies is to use automation and artificial intelligence technology for compliance. Common technologies include:
- Â Computer-assisted coding solutions
- Â Claims scrubbing software
- Â Automated compliance checks
- Â Real-time coding validation alerts
By implementing technology, you will minimize the risk of human error and confirm that your claims are compliant prior to submitting them to your payers.
Use Remote Medical Billers and Coders
Many medical practices have started using remote medical billing and coding services so that they can remain compliant and be more efficient. Most remote medical billers and coders are certified professionals who are knowledgeable of current regulations. The benefits of using remote services include:
- Â Access to specialized expertise
- Â Decreased staff costs and overhead
- Â Scalable and adaptable services for growing medical practices
- Â Higher accuracy and quicker claim processing times
Remote medical billing teams can provide ongoing compliance support for your practice without increasing your payroll.
Established Clear Compliance Policies and Systems
Establishing a formal compliance program demonstrates that due diligence was performed. This will also protect your practice when you are audited. Compliance policies should describe both coding standards and policies that govern billing processes and assignment of compliance responsibilities. Examples of core compliance program components include:
- Â Written policies and procedures governing compliance
- Â A designated compliance officer or team
- Â Reporting channels for compliance concerns
- Â Regular training programs for compliance and documentation of training.
Having a documented compliance program reduces legal liability as well as promotes accountability throughout the organization.
Partnering with Medical Billing and Coding ExpertsÂ
Some healthcare providers do not have enough resources to handle compliance on their own. Therefore, it makes sense to collaborate with an experienced partner providing medical billing and coding services that will bring expertise, technology, and workflow systems focused on compliance. The advantages of working with an external service provider like RCM Workshop are as follows:
- Certified coding and billing professionals to help ensure accurate submissions
- Continuous monitoring of changes and updates to regulations
- Access to advanced technology, compliance tools, and reporting/analytics
- Reduced administrative burden and associated risks
By using the services of external partners, healthcare providers can remain compliant and focus their attention on care.
Compliance is no longer a matter of choice in medical billing and coding. Providers must adopt a proactive approach, such as investing in training, utilizing technology, outsourcing medical billing and coding services to medical billing specialists, and reinforcing accountability and audit processes.
