How Does Medical Coding Affect The Revenue Cycle

The quote translates that revenue is vanity, definitely an achievement, but it’s not a complete picture of the company’s success. If the cash is not pouring into your business, there are high chances the cycle could be disrupted and the overall pipeline would be broken or distressed. A Medical Billing Company in New Jersey can fix this pipeline and ensure a proper flow of better cash and streamlined operations. 

To let your revenue cycle stream in a unified direction and your business uptake momentum, you need to balance out a lot of intricacies in your healthcare. One of the prominent players is “Medical Coding”, which can downturn your profits and ROI.

The healthcare services are a two-way road – translation of healthcare services into billable codes and preparation and submission of claims to insurance companies for reimbursement. 

Any bumps on these roads or any wrong medical code could hamper the overall process and impact the revenue cycle. 

Let’s decode each detail and dive into understanding the entire process.

What is Revenue Cycle Management in Healthcare?

Revenue cycle management refers to systematics, structure and coordinated processes managing the financial aspects of patient care in healthcare organisations. It includes every component, from patient interaction with the healthcare system scheduling to the final payment and reimbursement.

Revenue cycle management includes multiple processes and coding and claim submission is a crucial aspect that can make feast or famine. Either turn profits or redirect to denial, if not adhered to as per laws. A Medical Billing Solution can undertake the entire process, take care of intricacies and ensure that reimbursement is easy without any hindrances.

Role of Medical Billing Solution

Medical coding is converting healthcare diagnoses, procedures and other services into universal medical alphanumeric codes. There is each code for a patient’s diagnosis procedures performed to treat diagnoses. Whether it’s Regence or Premera, commercial insurance companies, or regulatory payers like Medicare and Medicaid, insurance companies adhere to these standard codes to settle claims and follow up.

Medical Billing services in New Jersey is skilled and knowledgeable with all these processes of patient billing practices, compliance with regulations, claim denials and much more. As a healthcare service provider, you don’t need to memorise codes, comply with guidelines or even evolve with a dynamic environment, all you need is the approach of professionals. 

Equifax found in an audit that hospital bills above $10,000 have a tentative error amount of $1300. This causes doctors to lose around $125 billion each year, all due to poor billing practices. 

Being a practitioner, you can’t afford to lose hard-earned cash in vain. Streamlined medical billing is not just a win for doctors but also for patients. Try outsourcing with Medical Billing Services New Jersey.

As per Becker’s Hospital Review, 80% of US medical billing contains errors.

Don’t let errors in medical billing and coding termite your profits; choose a Medical Billing Solution for streamlined and better operations. 

What are the top challenges in Medical Coding, and How to optimise it?

Responding to evolving and dynamic medical coding challenges is common. Hospitals and healthcare staff do not comply with efficient processes and the latest codings, which subsequently costs their organisation. Administrative waste is a major contributor to rising costs and impacts 30 percent of healthcare spending. Beyond the rising rates of healthcare, wasted time in the workforce can deteriorate cash flow longer than necessary.

Healthcare organisations must emphasise this factor and outsource this functioning to skilled and knowledgeable Medical Billing services in New Jersey to improve their bottom line.

How revenue cycle management can improve the medical billing process?

Understanding healthcare revenue cycle management may be difficult, especially when you are a busy healthcare professional or manager. If you know a few strategies for improving your medical billing, it can be a smart option. Here are some tips that can help you manage your medical billing process with the help of revenue cycle management.

Patient registration

This is the first and most important stage of revenue cycle management. You have to register patients and schedule appointments with the doctor for them. You can automate these processes by taking patients’ information in advance of their appointment and give your healthcare providers some time to process it.

Eligibility verification

This includes gathering the patient’s data for insurance and verifying their eligibility. It helps to verify if the patient has given the correct information or not. If they have given inaccurate information or ineligible insurance, it might lead to claim denials later in the revenue cycle. 

Claims processing

Claims denials can have a direct negative impact on your revenue cycle. The best way to reduce claim denials is to help your staff throughout the medical billing process of patients. They can understand difficulties and provide the right solutions so that your patients’ claims can move rapidly through the revenue cycle. Usually 

Manage claim denials

The insurance company don’t approve all claims. They reject it when they find some error. Common claim errors include missing information, late filing, eligibility issues, and duplicate claims. These errors can be easily prevented by creating a claims procedure and giving attention to detail. Revenue cycle management can track claim denials to check if there are any consistent errors and communicate with your team regarding concerns about claims before submitting.

Collect payments

After the patient’s claim is granted, the insurance company compensates the healthcare provider depending on the patient’s eligibility. If there is any unpaid amount after insurance payment, the provider is responsible for contacting the patient and collecting payment. Revenue cycle management speeds up medical bills by improving claims processing. Revenue cycle management also plays an important role in front-end tasks like insurance eligibility verification. This helps to avoid collection delays.

Why Akshar MedSolutions? 

The team at Akshar MediSolutions is made up of certified and enthusiastic experts with expertise in the fields of business consulting, information technology, and medical billing. Over the past ten years, our leadership team has worked with numerous hospitals, clinics of all sizes, labs, and individual doctors.

  • A reputable brand in the healthcare sector with knowledgeable resources to reduce denials and increase revenue flow. 
  • The sole reputable provider of HIPAA-compliant medical billing services that provides a full array of free cloud-based EHR, RCM, and practise management solutions 
  • We make sure everything is accurate and of the highest calibre, which has enabled us to expand hundreds of fruitful alliances with hospitals, clinics, and other healthcare facilities. 
  • Our IT team is accessible around-the-clock to offer technical support as well as their knowledge to increase cash flow and employee productivity.

Improper Coding

Often in a hurry to accomplish the task, medical coders either neglect some codes or add too much information. Fitting the code in the right puzzle is crucial for the reimbursement process. The Centers for Medicare and Medicaid Services predefine hierarchical coding categories. The framework or structure is designed to improve health outcomes and reduce plan costs. Undercoding or overcoding can lead to potential penalties and fines. To avoid this pitfall, seek clarification from the provider or get help from supervisors and auditors. 

These are a few to mention. Some more include – misinterpretation of modifier guidelines, insufficient documentation, ignoring coding guidelines and more. 

It’s not just hospitals that gain benefits. Everyone is in the loop, be it healthcare providers, insurance providers, patients, researchers, or healthcare organisations. 

Medical coding is complex. One mistake can take you to rejection of reimbursement. Claim denials are prevalent and cause financial strain. Don’t dent your revenue cycle; get help from Akshar MediSolutions.

Call us or learn more about our process; we are just a call away. +1 833 248 7463

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