Best Medical Coding and Billing Solutions for 2023

medical coding and billing December 29, 2022

There is much complexity in medical billing and coding. No matter how well-organized a billing department is, dealing with the discord of codes can be challenging. Moreover, untrained staff who file claims can make inadvertent errors that result in substantial financial and time losses. 

Medical billing and coding errors account for most claims denials and payment delays. Another issue is that frequent errors can have a negative impact on the relationship between you and your patient.

The issue of medical coding and billing is pervasive. Why is this so? Is there a way to avoid medical billing and coding errors?

As we move into 2023, we’ll discuss some common challenges and the best medical coding and billing solutions.

Three Common Challenges In Medical Billing and Coding

According to BMC Health Services Research, medical coding errors could lead to revenue loss. Simple mistakes can occur; human error must be allowed for, but lost fees drain the finances of a healthcare facility, which is why medical billing departments must minimize them.

Below are three common challenges that medical billers and coders face:

1. Usage of Outdated Coding Guides

To accurately bill for services and assign diagnosis codes, it’s crucial to have the latest coding materials. Each year, medical billing companies and practices should update or purchase the latest coding publications to ensure accuracy in billing and coding.

AMA, CMS, and WHO are the organizations that maintain and update the three principal medical coding codes every year. Coders are responsible for learning any new codes or reorganizations as they become available and using them correctly. This is partly because professional organizations like the AAPC and AHIMA require members to complete a certain number of education credits every two years.

However, failing to append the correct codes illegally inflates your practice’s revenue.

2. Improper Coding

The following reasons contribute to claims being coded incorrectly:

  • The unbundling of charges that need to be handled under the same procedure code
  • The practice of upbilling and underbilling
  • Inconsistencies in codes
  • Missing codes
  • Billing CPT codes that are not on your insurance provider’s list

Upbilling and underbilling can be fraudulent acts, but they may also be accidental. 

In the same regard, erroneous coding leads to poor patient care and trouble with reimbursements, but how does the responsible party address these issues? Those medical practices with a history of coding mistakes may be subject to fines and/or federal penalties.

The False Claims Act (FCA) enters at this part. It provides enforcement for false claims, and the consequences may include monetary penalties or legal issues. 

3. Missing Documentation

To pay claims, all insurance providers require documentation. If you don’t provide it, they may deny your claim and send it back to you, in which case you will have to resubmit it with the necessary documentation. The American Medical Association (AMA) estimates costs between $21 billion to $210 billion in claims processing inefficiencies each year.

At the same time, medical billing specialists need help assigning the right codes and billing patients correctly when physicians or other healthcare providers turn in sloppy paperwork. 

Best Medical Coding and Billing Solutions for 2023

There is a great deal of interest among healthcare firms and organizations in finding the best coding and billing solutions for 2023. With these features, they know that their practice will be able to advance faster than their competitors. 

1. Medical Practice Management Solution

A practice management software serves as a lifeline for medical practices. It enhances the efficiency of your practice by satisfying customers. Among the core capabilities of practice management software are:

  • Adding patient information to the database
  • Recording patients’ demographics
  • Managing billing operations
  • Streamlining billing processes
  • Processing and submitting claims for payment

Hiring a third-party service provider’s medical coding and billing services, streamlining all these tasks so healthcare practices can focus more on patients.

Furthermore, you should choose a practice management system with coding automation that meets current coding requirements. With software that allows you to list only the codes specific to each medical insurance carrier, you can easily reduce billing time and prevent errors. It is much less likely that your staff will make mistakes when they can quickly look up diagnosis and procedure codes.

2. Medical Coding and Billing Training/Education

Medical billing and coding are becoming increasingly complex for clinics dealing with different insurance companies. As complexity rises, coding certification becomes increasingly valuable.

Your clinic will reap several benefits from medical coding training from a certified professional. For example, ensure your staff is properly trained to recognize medical documentation needs. Your billing software should allow you to attach documents to your claims simultaneously. In this way, you’ll experience an increase in the efficiency of the workflow in your office.

Similarly, well-trained employees will code more accurately, easing the process of filing claims and receiving reimbursements. You will increase revenue and reduce refilling and appealing costs by minimizing claims rejections and denials.

3. Medical Outsourcing

Medical coding outsourcing refers to contracting the work to a third-party company instead of completing it in-house. Depending on your agreement, many medical billing and coding companies may handle all or most of your medical coding needs. They must also ensure that their staff is up-to-date on the latest coding requirements and skills. Medical coders often work remotely, but you can hire them in your practice.

Outsourcing medical coding has some major advantages, including:

  • Keeping Up-To-Date With Certifications.

It takes much time to keep up with certifications and updates. Medical coding can undergo substantial changes when a major update occurs. For example, ICD-10 led to a significant increase in codes. If you hire a third-party medical coding company, they will handle these issues for you. Having the right coders working on your charts ensures that their skills, certifications, and knowledge are up-to-date.

  • Cost-Effectiveness

It can be more cost-effective to outsource your medical coding than hire and maintain an in-house team. The price will be higher if you hire medical coders with specialization and superior skills. By outsourcing, you can employ top-level coders at a lower cost.

  • Flexibility 

The flexibility of contract medical billing and coding companies can be superior to hiring an in-house team. Outsourcing provides you access to an extensive network of coding experts. Moreover, the coding company can assign more employees to do your work on a busy day so you can submit claims and receive payments quickly.

  • Transparency

Your coding company is the one to provide you with detailed performance reports about your medical billing. They may send you these reports automatically or upon request. This way, you can get a clear view of your practice’s coding and billing, which helps you gain a more comprehensive understanding of your practice’s operations. 

  • Security and Compliance

Regulatory compliance and security are major concerns for healthcare organizations. To protect against data loss and other cyber incidents, you need robust disaster recovery plans for medical coding and billing. Additionally, you need to ensure that you comply with HIPAA regulations.

Medical coding firms specializing in security and compliance will understand your coding concerns. You can always trust your coding company to take the appropriate precautions.

Furthermore, medical coding outsourcing companies can also conduct coding audits, provide research support, and improve clinical documentation. 

You should consider outsourcing if you’re looking for an easy, hassle-free way to improve medical coding and billing. Many healthcare organizations can benefit from this approach in a variety of ways.

Tap Into Our Expertise

Indeed; many healthcare establishments struggle with common coding and billing issues. To ensure your practice’s prosperity in 2023, we offer the most effective solutions mentioned above.

These medical coding and billing solutions will help your medical practice compete in an increasingly competitive market.

At 5 Star Billing Services Inc, we offer the highest level of performance for high-quality medical billing and coding. Save your money by outsourcing to a professional billing service.

Schedule a call with our experts today!

Leave a Reply

Your email address will not be published. Required fields are marked *

  • © 2024 5 Star Billing Services, Inc.