In healthcare’s increasingly value-based landscape — where provider income is tied to outcomes, hospital prices are accessible and transparent, and consumers play a larger role in managing their care — it is essential that health systems correctly record and bill for patient services to maintain revenue cycle integrity.
Mistakes or variations in this data can lead to compliance violations, rejected claims, and over or underpaying for services. It also affects the patient experience and perceived quality of care, impacting consumer satisfaction and health systems’ bottom line.
Accurate code capture — the process doctors follow when recording information on patient encounters — safeguards organizations from these hiccups. Hospitals can support code capture through coding compliance, which ensures health systems are:
- Maximizing their revenue
Is your organization leaving money on the table? Incomplete or inaccurate code capture could lead to undercharging for services. Code compliance ensures your hospital is getting reimbursed for services and maintaining a healthy revenue cycle.
- Following government policies
Code compliance keeps your hospital in good standing with government regulations. Non-compliance could lead to government fines or even jail time, so it’s vital codes are entered completely and accurately.
- Reducing claim rejections from private and public payers
Insurance claim rejections are a colossal pain in the neck, especially when they are tied to billing errors or incomplete information. Compliant code capture prevents these mistakes from happening in the first place so that insurance claims go through without a hitch.
- Maintaining accurate medical records
An accurate medical record improves patient-provider communication, protects healthcare professionals against liability, and gives patients a fuller picture of overall health. This can improve patient outcomes and quality of care, which are critical benchmarks of success in an increasingly value-based industry.
Building a Culture of Compliance
Promoting accurate code capture also helps create a culture of compliance within healthcare organizations, increasing productivity, strengthening employee engagement, and boosting staff morale. Combined, this contributes to the success and health of your organization, giving you a competitive edge as healthcare becomes increasingly fragmented and consumer-centric.
Improving Code Compliance at Your Health System
Code compliance is the bedrock of complete and correct coding capture. However, many organizations struggle to maintain full compliance due to the sheer workload providers take on, ineffective processes for collecting and interpreting data, and ever-changing laws and regulations. Still, your health system can put strategies in place to improve coding compliance and code capture.
- Educate providers and clinical staff
Relationships between coders and clinical staff risk becoming adversarial, especially when providers feel like they’re being told how to administer medicine or work with patients. However, when you educate them on best practices for documentation and coding prescriptions, medical conditions, and patient information in a compliant way, they are more likely to work with you and follow your guidelines.
- Proactively partner with providers
Doctors have a wealth of experience and knowledge working with patients, payers, and coders. They also know how providers think and what they are up against, so use that knowledge to your advantage! When providers collaborate with coders and CDI specialists, they can ensure the data is accurate and develop solutions for improving clinical documentation in the future.
- Use technology to your advantage
Computer-assisted coding makes it easier to document clinical encounters for optimal reimbursement and quality measures. Moreover, business intelligence tools that analyze your health system’s data, coupled with provider expertise, can help give you insights and actionable steps to improve your clinical documentation and support more accurate code capture.
Improving Code Compliance in Your Organization
With healthcare transitioning to a value-based model, accurate code capture is essential to maintaining revenue integrity, preventing government fines, and maximizing ROI in hospital systems. Coding compliance ensures that code capture is accurate, complete, and throughout every level of a healthcare system. Hospitals can set their providers up for successful code capturing and compliance by putting the right teams and technology in place.
Learn more about Accuity’s solution and how it strengthens your hospital’s overall coding and documentation compliance and integrity.