A recent healthcare report concluded that the average time between filing a claim and collecting payment is almost 7 weeks. Healthcare providers always keep striving to reduce this time. Revenue cycle management is a long process and should be done correctly. Medical coding is an integral part of the RCM process, and the reimbursement amount healthcare providers get usually depends on the codes used. Medical coding requires a thorough understanding of codes and modifiers. Certification and experience are needed to enter the correct code, bundle them, or add a particular modifier. However, medical coding is time-consuming and takes up most of the time dedicated to revenue cycle management. However, with technological advancement and the development of software, medical coding has become easy and quick.
What is medical coding software?
Medical coding software is a tool that enables medical coders to assign procedure and diagnostic codes to medical data while maintaining patient confidentiality. Medical coding software does not replace human coders; it can simplify complex coding in a few clicks. Medical coding softwares allows healthcare providers to hire less staff without compromising productivity.
CAC
CAC (Computer Assisted Coding) is software that leverages NLP (Natural Language Processing) to aid medical coders in assigning codes. CAC systems analyze clinical documents like summaries and identify key phrases and terms. It then suggested medical codes for the phases and terms it identifies. Medical coders review these suggestions and make the necessary adjustments.
Autonomous coding
Autonomous coding is a fully automated AI solution that codes charts quickly and accurately. It requires minimum or even zero human intervention as it uses artificial intelligence or logic to code. Though autonomous coding is effective, it is not yet a replacement for human coders.
How does medical coding software work?
Medical coding software gathers patient information such as treatment, diagnosis, equipment, and procedures from EHRs (Electronic Health Records). It then assigns appropriate codes to each procedure, diagnosis, medical supply, and medication according to coding standards, including ICD, CPT-10, and HCPCS coding. This medical coding software identifies and corrects inaccuracies to comply with NCCI (National Correct Coding Initiative) and other regulation guidelines. Later these codes enter specialized software or database applications designed for medical coding. These tools use references like clinic coding and advanced tools to ensure precision. Finally, it transmits the coded data to payers for reporting purposes and reimbursements. Medical coding software also ensures that healthcare services are appropriately represented and processed, leading to financial stability for the practice.
Benefits of using medical coding software
Medical coding software is highly beneficial to healthcare providers and payers. This software makes the coding process seamless. Here are the benefits of using medical coding software.
Reduced errors and improved accuracy
Medical coding software automates numerous manual tasks, helping healthcare providers process claims precisely. These software have multiple features that reduce manual data entry, minimizing typos and misinterpretation errors. Medical coding software ensures healthcare providers stay on track with the latest coding guidelines and reduces the chances of wrong code selection. They also identify coding errors before submitting claims, reducing the medical coding denials.
Improved compliance
Using medical coding software, healthcare providers can stay audit-ready and compliant with regulatory guidelines. This helps them reduce fines or penalties for non-compliance. Medical coding software identifies coding violations and flags inconsistent medical codes, reducing disruptions and audit risks.
Increased productivity and efficiency
Features like dictionaries, integrated EHR systems, and quick-access coding libraries help healthcare providers eliminate repetitive tasks. Few coding softwares also have batch coding features that help in high-volume coding or with repetitive procedures. This software offers a central platform for healthcare providers and payers to communicate promptly, increasing efficiency and productivity.
Better patient outcome
Accurate and timely documentation contributes to better patient outcomes. Medical coding software prevents patients from receiving unexpected bills, reduces billing disputes, and improves patient satisfaction. It also provides financial flexibility to practices, allowing them to invest better in services and equipment. Higher cash flow helps healthcare providers offer high-quality patient care.
Enhanced revenue cycle management
Medical coding softwares offers accurate codes and support documentation, leading to faster processing time by payers, resulting in faster reimbursements for healthcare providers. With reduced coding mistakes, denials for healthcare providers are also reduced. It leads to better cash flow and revenue cycle. Medical coding software streamlines the entire RCM by integrating with billing systems to transfer coded data to the billing department.
Adaptability and scalability
It is challenging to upscale or downscale human coders depending on the needs of the claims submitted. Medical coding software is adaptable and can scale according to the requirements. It can also adapt to constantly evolving medical coding guidelines, ensuring practice stays compliant. Healthcare providers can also stay updated by accessing the most relevant and recent medical coding information.
Data-driven decision making
Healthcare providers get the most comprehensive and accurate data using medical coding software. This software can generate detailed reports on coding trends, utilization patterns, and physician coding practices. Practices can use this information to detect the areas of improvement, make intelligent decisions, and refine coding methods. Healthcare providers can compare their coding practices with industry benchmarks, allowing them to detect regions of optimization and potential revenue leaks.
Enhanced data protection and security
Healthcare is the sector that has the most sensitive information and is more prone to data breaches. Medical coding software offers features like encryption, audit logs, and access control. This software also allows authorized personnel to access the data. Medical coding software uses advanced security protocols to protect against cyber threats like malware, unauthorized access, etc. It prevents data breaches and maintains the privacy of patient data.
Key features for medical coding software
Medical coding softwares must have features like customizable code sets, integration with EMR systems, real-time error checking, automatic code suggestions and more. Here are the top 10 key features of medical coding software.
Reporting and analysis
Medical coding software must perform data analytics and provide reports on coding errors, patterns, and financial performance.
Cloud-based solutions
It should be hosted on the cloud to offer better accessibility from anywhere using an internet connection.
Advanced AI
It should use AI and NLP to suggest and interpret clinical codes.
Patient scheduling integration
Medical coding software should have the capability to integrate with the patient appointment scheduling systems.
Real-time error detection
Detect and flag potential coding errors real-time. It prevents errors before they impact billing, reducing rework and denials.
Code suggestions
Medical coding software should use AI to suggest correct codes based on clinical notes.
EHR integration
It should easily integrate with any electronic health record system like HL7 or FHIR.
Audit reporting
Detect and track changes to provider history of adjustments and coding decisions.
Educational resources
Medical coding software should provide access to coding guidelines, community forums, and tutorials.
Mobile access
It should offer to perform tasks and access coding tools via mobile devices.
HIPAA compliance
Medical coding software must adhere to all the payer guidelines and should stay compliant with HIPAA regulations.
Common challenges when using medical coding software and how to overcome them
Medical coding software is vital for healthcare providers to streamline their RCM. Though it has numerous benefits, it also has challenges. Here are the common challenges when using medical coding software and effective ways to overcome them.
Coding errors due to software limitations
Medical coding software relies on previous data and predefined rules to suggest codes. These systems can process huge amounts of data but fail to account for the nuances of complex medical codes. Incomplete or inaccurate codes can lead to incorrect billing or denied claims, costing revenue loss. Coders and auditors should regularly review the suggestions, especially in complex cases. Medical coding software should also be updated with the latest regulatory changes and coding guidelines. Healthcare providers must thoroughly understand the software and know its limitations to reduce the likelihood of errors.
Lack of software customization
Many medical coding software systems are not fully customizable to the specific needs of healthcare providers. A rigid, one-size-fits-all system slows coding operations and increases errors. Healthcare providers should choose customizable coding solutions allowing and leveraging APIs to connect the software with other systems. Furthermore, involving end-users in the selection and implementation ensures the system meets real-world demands.
Compliance and regulatory risks
The healthcare industry is heavily regulated, and coding software needs to keep up with evolving regulatory standards. Many coding software programs lag behind the latest compliance guidelines, making it difficult for healthcare providers to stay updated and maintain accuracy.
Healthcare providers should invest in regular software updates that include the latest compliance and regulatory changes and implement a robust audit system within the software. Having a team dedicated to regularly reviewing claims for compliance before submission can further mitigate risks. Regular staff training on regulatory updates and coding best practices will also enhance compliance.
User training and adoption issues
Even the most advanced medical coding software is only as effective as those using it. Insufficient training or resistance to adopting new technologies among medical coders is real. A lack of proper onboarding can result in inefficient use of the software, underutilization of features, or even mistakes that impact the revenue cycle. Healthcare providers should invest in comprehensive user training programs tailored to different levels of expertise. Additionally, continuous education on system upgrades and new functionalities ensures users always utilize the platform to its fullest potential. Support from IT departments and regular communication with the software vendor will further aid adoption.
System integration issues
Software systems like electronic health records, patient management systems, and billing platforms may not always integrate seamlessly with medical coding software. Poor integration can lead to data silos, inefficiencies, and coding delays as staff navigate between different platforms. Healthcare providers must implement a fully interoperable coding solution that integrates smoothly with existing healthcare software. Regular system audits also help to identify integration issues early and also help avoid significant disruptions.
Choosing the best medical coding software for your practice
Choosing the right medical coding software is essential for healthcare providers. Multiple features medical coding software offers may not be required. Here is what practices must look for when choosing the right medical coding software.
- Is the medical coding software designed for their specialty
- Can the medical coding software integrate with their practice management softwares
- Does the medical coding software offer enough flexibility and scalability
- Will the productivity of staff increase while minimizing the turnaround time
- Does the software vendor have a community for support, and do they offer prompt assistance
- Is the coding quality and efficiency up to the expectations
What’s ahead in medical coding software: Upcoming trends and innovations
Medical coding software has evolved a lot since it started, but this is not the end. It is smart, but it is still evolving, and the features it brings to the table are limitless. Here is the future of medical coding software and trends expected to come shortly.
Artificial intelligence and automation
AI is all set to revolutionize medical coding. ML algorithms analyze medical records and help in code assessment, helping healthcare providers increase efficiency and accuracy. Automation streamlines the process and helps healthcare providers focus on more complex cases and exceptions. Currently, humans are required to validate and monitor the use of AI and automation. In the future, medical coders will do audits rather than code. Medical coders should start taking certifications specialized in coding to meet the expectations of the growing needs.
Remote and telehealth coding
With the growth in telehealth services, opportunities for remote coding have evolved. Remote coding reduces geographical limitations, offers flexibility, and helps medical coders maintain a work-life balance. Medical coding courses can be taken online, and in the future, medical coders could fully strive to work online and remotely.
Data insights and advanced analytics
Data insights and advanced analytics are enhancing the value of medical coding. Healthcare providers can detect error patterns, coding trends, and areas for improvement. These insights help to optimize the revenue cycle, enhance patient experience, and make informed decisions.
How can PCH Health help?
Medical coding software is not wholly autonomous; healthcare providers need the support of experienced medical coders to submit error-free claims. PCH Health offers autonomous medical coding solutions to healthcare providers across the globe. We offer a perfect blend of experience and automation to help you surpass your KPI goals. Connect with our medical coding experts here to learn more.