An Inside Look at a Coder’s World
Medical coders are the unsung heroes of the healthcare industry. They are the link between the physicians and the payer that ultimately determine what the patient pays and what their treatment is. To those outside the industry, it may not seem like such an important task, but for those involved in the day-to-day they understand the amount of time and money coders can save – and cost – the hospital.
Coding is no easy task. This year alone, CMS added 273 codes, deleted 21 codes and made 30 revisions to codes pertaining to various treatments. Regulations are constantly changing making it more difficult to keep things up-to-date and compliant. Incorrect coding can be extremely costly to a hospital – in fact – according to a study by Change Healthcare, hospitals are at risk of losing out on almost $4.9 million (3.3%) of net patient revenue due to denials of claims, often a result of incorrect coding. Not to mention, an error in coding can impact a patient’s treatment. Each code has its own unique meaning and being off on any digits can provide the care team with the wrong instructions on how or where to treat a patient.
Supporting the coder supports hospital success
Coding is huge responsibility that impacts several areas of the hospitals, so how can different departments support coders? For auditors it may be as simple as viewing the coding department as an extension of their own team. Learn how you can best work with the coding department to rectify mistakes and improve on areas that could be improved for the future. It can be easy to point fingers when an error is made, but by instilling the mindset of teamwork you can help increase coders’ confidence for future success.
The support of the C-suite is also important for the coding department and can be what makes or breaks a strong department. With the backing of the C-suite, the coding department is more likely to receive educational resources, budget and appropriate staffing. Often times short staffed departments with high production goals end up relying on cheaper overseas coding companies that may enlist uncertified, undertrained or new coders, which can lead to errors and wasted time. Setting coders up for success sets the hospital up for success – a win-win for everyone!
Of course, it is up to the coders themselves to ensure they are keeping up-to-date on new codes or code changes. They need to be aware of the sequencing recommendations and be sure that the most specific diagnosis is listed for reporting. And while coders don’t always agree, they should be aware of and familiar with the clinical indicators and criteria the hospital has in place to make the process easier.
Every department within an organization impacts patient experience and comfort levels. Each are faced with their own challenges and can be overwhelmed with the day-to-day tasks they deal with. As one piece of a larger puzzle, the decisions, success and errors of the coding department can impact several others. Working as a team, providing access to necessary resources – whether technology or educational information – and focusing on the bigger picture helps to ensure coding success and the success of the hospital.