The Merriam-Webster dictionary defines commodity as “something useful or valued.” In healthcare, coding is the most important yet silent commodity in the revenue cycle. So, what is Medical Coding Commodity and why is it essential? Let’s understand it…
With over 68,000 ICD-10-CM medical diagnosis codes and over 87,000 ICD-10-PCS procedure codes for providers to comb through, selecting the right combination of diagnosis and procedure codes can be a daunting task.
Medicare and other major insurance companies have their own “billing guidelines” which must be followed to get paid. Certified coders know where to look for the information to find what diagnoses may be used to determine medical necessity for various procedures.
For instance, Botox®, this drug is covered by Medicare and most insurance companies for Migraines, but they will not pay for it if you want to smooth out your facial wrinkles.
Most providers do not have the time to look up if a specific diagnosis is payable for each appointment, certified coders are essential to getting providers paid.
Electronic Medical Records (EMR) and Practice Management systems are supposed to assist with coding however, the EMR does not have the experience working with insurance companies who may have different policies on how to code a single procedure. Some insurers may require a modifier – while some may not.
Some may only pay when a procedure is paired with a certain diagnosis – while some may be flexible. Each insurer is different, and each state may also have different guidelines.
Certified professional coders added into a revenue cycle allows a critical view on a patient encounter prior to being sent to payers.
Coders can focus on certain specialties such as orthopedics, podiatry, optometry, etc. garnering experience from the different insurance companies and maximize payment for the providers on the first pass of a claim.
When a provider is searching for the right code that is time they are not spending with their patient. Any process improvement program would tell you wasted time/wasted resources is inefficient. Inefficiency can cause a debilitating effect on a medical practice.
Investing in an experienced coder will more than pay for itself by maximizing reimbursement and decreasing claim denials.
The combination of a CPC and experienced biller will improve compliance and increase cash flow, maximizing a clinic’s profits.
To tap into this “Coding Commodity”:
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