Myriam Johnson, RHIA, Coding Manager, KIWI-TEK | January, 2019

Medical record coding professionals face added duties, technology transitions and new colleague conversations in the year ahead.

  • Professional fee physician coding piles up as hospitals continue their march into outpatient care settings.
  • EHR conversions and upgrades leave DNFB backlogs and rejected claims in their wake.
  • Healthcare executives push to break down departmental silos and reinvent workflows—including those within the revenue cycle.

Each of these challenges task coder productivity and accuracy. However, when combined, they are certain to keep medical record coding teams in the spotlight. This blog post takes a close look at these three catalysts for change coming together to reshape the coding profession in 2019.

Get outpatient coding right

At KIWI-TEK, the fastest growing segment of our outsourced coding services is professional fee coding. Physician coding involves multiple layers of technology and expertise. Initially touted by EHR and EMR vendors as easy and fully automated, proper physician code assignment is tougher than it looks. Furthermore, as health systems rapidly acquire practices and subsequently take over their coding and billing operations, coding productivity and accuracy gaps are exposed. Errors signal the need for credentialed coders versus automated codes generated from physician documentation within the EHR. In 2019, physicians and other outpatient care providers will recognize the benefits of having professional, credentialed coders take control.

  • Free up physicians to spend more time on patient care, not paperwork
  • Reduce claims rejections and payer denials in outpatient settings
  • Increase entitled reimbursement through more complete coding
  • Ensure compliance with unbundling rules and/or applicable modifiers
  • Relieve the burden of physicians having to stay current with coding changes

The most effective way to meet these goals and improve outpatient coding is to move responsibility for it under the umbrella of the health system’s HIM department. We predict this trend to explode in 2019 along with cross training of coders to capture both inpatient and outpatient professional fee codes at one glance, rather than having two separate groups do the work.

Keep up with EHR transitions

Nearly every health system in the nation is transitioning to a single EHR platform. With this move, we see a new line of work for HIM professionals in EHR coding and billing edits. Here’s why.

  • Dramatic increases in coding and other claims edits occur during and after an EHR implementation, conversion or upgrade.
  • These coding and billing edits create DNFB backlogs and revenue loss.
  • Coding and billing teams become overloaded with claims cleanup while also trying to meet day-to-day productivity demands.

These same issues were identified in 2018 and will continue to wreak havoc on medical record coders in 2019. However, instead of coders taking time during the coding process to work EHR edit queues, we suggest a designated team of coding and billing edit professionals. Teams that specialize in edits are the preferred strategy to maintain coder productivity and focus. Here are three best practices to consider.

  • Specialized edit professionals are thoroughly trained in specific EHR system edits and work queues.
  • Designated edit teams clear all edits within the EHR while staying abreast of all the various payer rules and requirements.
  • Edit teams can be subdivided to address specific edits and work queues. For example, queue #131 includes all medical necessity edits and queue #132 includes all patient demographic edits.

Break down silos, especially with CDI

There are always revenue cycle issues when poor communication exists between clinical documentation improvement (CDI) and coding teams. Good collaboration between medical record coders and CDI specialists resolves issues proactively, while patients are still inhouse. Full integration of the two teams achieves important awareness and efficiency goals to:

  • Understand clinical validation rules and best practices
  • Navigate indicators from test values that steer coders to a query
  • Build query consistency between CDI and coding
  • Establish clear understanding of all documentation, coding and payer rules

Continued need for more inpatient coders

The ongoing need for more inpatient coders is real. This is especially true with new roles, tasks and demands. A strong inpatient coder remains the most requested resource at KIWI-TEK. Addressing productivity lags for ICD-10-PCS coding is a primary factor. While outpatient and inpatient diagnosis coding benchmarks are back to ICD-9 levels, surgical coding in ICD-10 continues to be a challenge in the industry. Monitor this blog throughout 2019 to learn valuable strategies to overcome coding’s top challenges in the year ahead and reinvent your coding career. If you’re not already a subscriber, sign up here: https://www.kiwi-tek.com/blog-subscriptions/