Outpatient Coding: Overcoming the Biggest Challenges
However,theanticipatedresurgenceinoutpatientvolumeswillmeanmore struggleswithaccurate,efficientcodingandrevenuecontainment.
Comparedtoinpatientcoding,outpatient(O/P)codingissubjecttomore uniqueconstraintsandvariables.Itrequiresskillsetstailoredforspecific services,anddespitelowerper-encounterreimbursementrates,themuch highervolumesmakeoutpatientcodingacriticalrevenuedriver.
Atthesametime,sinceonlyasmallnumberofoutpatientencountersare audited,theresultisalessthanadequatecodingworkflowthatfailstoyield thefinancialvalueofO/Pservices.
Most Common Challenges of Large-Scale O/P
Coding
Whenitcomestoidentifyingchallengesinoutpatientcoding,accuracyand complexitystandoutastwoofthemostprominentfactors.O/Pcoding accuracyisoftensubjecttolowvisibilityandhighvariability.Thesefactors raisetheriskofrevenueloss,andprofitsslipthroughthecracks.
Disparityandlackofuniformityinoutpatientcodingmanagementacross differentorganizationsexacerbatetheproblem.Intheabsenceofaneffective QualityControl(QC)process,theresultingskillsgapoftencreateschancesof potentialerrorsthat,ifleftunchecked,couldleadtosignificantrevenueleaks andcompliancerisks.
Some of the most common outpatient revenue integrity challenges include:
• Claims editing: ClaimseditingwasintroducedaspartoftheO/P codingprocesstoreducetheimpactofmissingdocumentationandcode duplication.Complextools,suchasclaimsscrubbingsoftwareand analytics,areused.Asaresult,providersfinditchallengingtonavigate theclaimseditingecosystemamidthegrowingvolumes.
• Disparity between professional fees and hospital O/P coding: The growingneedtointegratephysicianpracticesandhealthcaresystems liesattheheartofthisproblem.Mergingprofessionalfeeserviceswith facility-basedO/Pcodingcanbetricky,especiallysinceeachrequires specifictraining,skills,andknowledge.
• Changes to coding guidelines: Codingguidelinechanges,whichoccur asoftenasonceayear,arenecessarytoimprovecarequality,butthey canbeapainpointforO/Ppractices.Regularchangesmeancoders muststayupdatedthroughperiodicreviewstoensureaccuracy.Onthe flipside,usingoutdatedcodesisaprimarycauseofincreaseddenials, delayedreimbursements,andinappropriatecharges,impactingthe revenuecycle.
• Managing medical necessity: Hospitalsandclinicsthatlackevaluation processesforthemedicalneedofproceduresatthefrontend frequentlymissoutoncodesanddocumentationthatsupportavalid diagnosis.Asaresult,hospitalsoftenwriteofflowercostsofoutpatient diagnostictestsinsteadofresubmittingclaims,whichcausessignificant hiddenrevenuelosses.AccordingtotheAdvisoryBoard,asurgein medicalnecessitydenialsisoneofthemostpressingchallengesmedical facilitieswithinadequateinfrastructuresface.
Overcoming the Odds: On the Path of Automation
WhenweconsiderthechallengesplaguingO/Pcodingpractices,the predominantlymanual,paper-basedprocessesimposeasignificantburdenon healthcarestaff.Thenegativeimpactsincludelowerproductivity,reduced capacityforcasereviews,andunder-optimizedDisease-RelatedGroup(DRG) assignment.ByleveragingArtificialIntelligence(AI)andNaturalLanguage Processing(NLP)capabilities,integratingAI/ML(MachineLearning)into automatedcodingsolutionswillfurtherenhancethepotentialofthesetoolsto simplifycomplexandtraditionallymanualprocesses.This,inturn,canhelp healthsystemssimplifystandardproceduresandhelpovercomethe shortcomingsinoutpatientcoding.
AGSHealth’saward-winningNLP-basedComputer-AssistedProfessional Coding(CAPC)solutionhelpscareprovidersachievegreaterqualityand accuracybenchmarks,whilealsosurpassingthemwithrapidandconsistent improvementthroughlearningmodels.
Thiscustomizable,comprehensiveservicehelpshealthcareprovidersenhance theiroutpatientcodingperformance.TheCAPCsoftwarehelpsfacilities improvetheirfinancialandorganizationalperformance.Thepowerfulclinical NLPengineleveragesdeepknowledgegraphstoautomateaccuratecode suggestionsthathelpreducethefinancialimpactsofdeniedordelayedand reworkedclaims.
The benefits include:
• Highercoderproductivity
• Increasedriskscorecapture
• Reducedcodingdenials
• LessernumberofdaysinAccountsReceivable(AR)
Withthehealthcareindustry’svalue-basedapproachtakingcenterstage, accuracyincodingandbillingismoreessentialthaneverbefore.Fortunately, AGSanditsAI-poweredservicesareheretoensureyouhitthemarkevery time.AGSmakesrecommendationsbasedonyourneeds,resources,andgoals. Thiscustomer-centeredapproachensuresyoureceivethesupportyourneed, andifyourneedschange,AGSisabletoscalewithyou.
Source of content:
https://www.agshealth.com/blog/outpatient-coding-overcoming-the-biggest-challenges/
