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The Importance of Hospital Coding: Maximizing Reimbursements and Compliance

August 31, 2023

Ensuring accurate coding and compliance reflects your patients’ diagnoses and care and encourages your facility to exceed revenue performance goals.

Many hospitals don’t have the expertise, manpower, or time to establish coding compliance and an efficient workflow. Partnering with a revenue cycle management expert with industry experience and advanced technology can help boost your reimbursements and strengthen your hospital’s compliance.

The Role of Hospital Coding in Revenue Cycle Management

Hospital billing and coding serve as the backbone of revenue cycle management. Medical coding translates medical services, diagnoses, procedures, and equipment into a set of universal medical alphanumeric codes used for claims submission and reimbursement. It ensures hospitals and healthcare providers are reimbursed for services delivered. Coding, claims processing, and collection are all crucial revenue-generating operations for any hospital. 

coronis health healthcare worker with mask filling out document

Understanding the Impact of Accurate Coding on Reimbursements

Accurate hospital coding leads to clean claims, faster reimbursements, and a positive bottom line. Medical codes are used to support the claims sent to a patient’s insurance provider, and claims paid by patients and/or insurance companies drive the financial operations of medical organizations. 

However, depending on the nature of the patient’s diagnosis and treatment, reimbursement can take weeks or months to be processed. This is why submitting the correct codes the first time around is necessary to get paid as quickly as possible. It also means that coding errors can lead to delayed payments or lost revenue.

Common Challenges in Hospital Coding and Their Effects on Reimbursements

Some of the challenges in coding for hospitals include:

  • Incorrect/missing documentation – failing to provide accurate and complete documentation can result in the loss of codable components, leaving room for coding inconsistencies and decreasing your billable expense reimbursements.
  • Changes in healthcare regulations and compliance standards – regulations constantly change in healthcare. Failing to stay current with these changes can lead to claim denials, payment delays, and poor cash flow.
  • Coding errors – using the wrong codes puts your billing department into a repetitive cycle of claims submission, denial, correction, and payment delays, which throws a wrench into your revenue flow.
  • Coding that is too general – this means taking accurate notes and abstracting all relevant information from medical reports. This process requires meticulous attention to detail. When coding is too general, hospitals miss opportunities to collect additional revenue. It also increases the likelihood of claim denials.

Strategies for Optimizing Accuracy and Efficiency

Here are three actionable tips to improve coding accuracy and efficiency:

coronis health hospital medical worker referring to document on clipboard
  • Leverage technology – Electronic health records (EHR) bring the paper-heavy billing process into the digital age, while computer-assisted coding (CAC) helps analyze documents to identify the right medical codes for clinical documentation. These tools speed up the coding process and increase accuracy and efficiency.
  • Perform regular audits – regular audits bring issues to the forefront so you can address them promptly. Sharing learnings and feedback with coders and providers helps improve operations and coding accuracy.
  • Outsource your coding – partnering with hospital billing and coding experts who work exclusively for revenue cycle management providers helps guarantee that claims are filed accurately. They can focus and pay attention to details that medical office staff may overlook in the flurry of their daily tasks and core responsibilities.

The Benefits of Proper Hospital Coding

Proper medical coding is useful for hospitals in the following ways:

  • It helps ensure full reimbursement – insurance companies and other healthcare payers rely on hospitals to accurately and completely describe medical tests, procedures, and devices provided for patients. Accurate coding means getting reimbursed promptly. 
  • It improves patient safety – proper coding helps assess a patient’s health, identify issues in healthcare quality, and influence new and changing health policies. 
  • It improves patient satisfaction – accurate hospital coding simplifies bills and helps patients understand their bills better. When billing is simplified, patients are more likely to pay quickly.

Improved Revenue Capture and Reporting

By implementing hospital coding and billing strategies, your hospital can significantly improve the efficiency and accuracy of its revenue cycle. You can minimize denials, reduce the need for time-consuming appeals, and optimize your revenue capture, leading to operational efficiency that boosts your bottom line.

Improved reporting also allows you to assess your organization’s current health by identifying errors that may occur throughout the billing process. Correcting those errors through proper reporting can reduce expenses from investigations and denied claims and, ultimately, optimize your revenue cycle from beginning to end.

coronis health hospital medical biller talking with client

Coronis Health is more than a medical billing company. We offer end-to-end revenue cycle management services that scale with your hospital. We act as your partner and help optimize your coding practices to improve the overall health of your revenue cycle. 

To learn more about hospital medical billing and how outsourcing can benefit your organization, schedule a 1:1 executive consultation with Coronis Health. 

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