The Importance of Ongoing Education to Maximize Your Revenue Cycle in Uncertain Times

Business of Medicine

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As the impact of the COVID-19 pandemic continues to affect daily program operations, maintaining accurate coding and clinical documentation is vital for managing operating margins, revenue collection and reimbursement. Coding integrity is an integral part of the revenue cycle and should align with your organization's overall strategic mission. Determining where your organization may have gaps is the first step to help decide where to focus efforts for additional education and resources.

Prior to the public health emergency (PHE), continuous reimbursement updates and payer rule changes along with regulatory coding audits were normal for health care. Now, differing payer guidance, effective dates and "special" instructions have been added, increasing the importance of accurate coding, billing and documentation efforts.

Although patient and staff safety must be the first priority, we must also ensure ongoing training and education is provided for our coding professionals as we continue to navigate this unprecedented pandemic.

In this rapidly changing environment, it is important for your program to assess what types of improvements in the overall coding process will bring the most benefit to your internal team, as each organization's coding needs will vary. A proactive plan to facilitate coding and documentation education is the best approach and will increase accuracy and quality, as well as decrease claim denials.

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Providing ongoing education will empower your team with knowledge to get it right on the front end, which is essential to cost per claim and timely reimbursement. Combining education with periodic audits can also help promote the professional growth and development of your coders and will likely pay dividends to your organization.

While most organizations have a target of at least 95% for coding accuracy, it is important to remember that this is a team sport that should involve all stakeholders in communication and education efforts. One of the most important relationships on the team is between the physicians and coders.

The effectiveness of improvement efforts will increase as they better understand each other's communication and documentation styles. As organizations build their ongoing educational plans for coders, it is also important to include time with the physician to help eliminate errors that could be caused by simple misinterpretation.

In our fee-for-service world, physician services are reimbursed based on associated CPT (Current Procedural Terminology) or the HCPCS (Healthcare Common Procedure Coding System) codes submitted on claim forms. ICD-10-CM diagnosis codes establish the medical necessity and reflect the acuity of the patient's condition for the service.

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With over 70,000 ICD-10-CM diagnosis codes and well over 10,000 CPT codes, it can be taxing to keep up without ongoing education. It is also beneficial to establish effective communication and a good relationship between your coders and physicians. This may be accomplished by allowing coders to observe during procedures in the cath or EP lab when it is appropriate and meets the facility rules and patient consent is obtained.

Additionally, working to establish an effective communication plan that provides ongoing feedback to the physicians is essential; consider a monthly or quarterly brief session with the coders.

Investing in ongoing education will allow your program to more easily cross-train coders as services continue to evolve to meet patient demand beyond the current PHE. As cardiology-specific coding experts, the MedAxiom Revenue Cycle Solutions team is the premier resource for cardiology coding. Services can be tailored to meet any organization's needs whether temporary or long-term, education and training, a simple phone call or a back-up coder.

Learn more about the MedAxiom Consulting Team and how experts can help you and your organization tackle issues such as revenue cycle management, patient access, staffing/operational efficiencies, adaptability and more. Contact Consulting@MedAxiom.com.

Keywords: ACC Publications, Cardiology Magazine, Current Procedural Terminology, Fee-for-Service Plans, Healthcare Common Procedure Coding System, International Classification of Diseases, Pandemics, COVID-19, severe acute respiratory syndrome coronavirus 2, Coronavirus, Public Health, Learning, Cardiology, Documentation, Physicians, Feedback, Growth and Development


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