You hear a loud pop in your left arm, followed by intense pain. You visit the doctor and sure enough, it's broken. As the doctor examines you, he or she will most likely be sitting at a computer during your visit typing notes, or writing down on a clipboard documenting what has happened to your arm. Once the visit is over, the doctor needs to get paid by the insurance company. This is where medical coding comes in. The doctor cannot simply send over the notes from your encounter. The insurance company requires a medical code. A medical code in this situation would look something like this:

"S52.92XA"

There could be a handful of similar codes that help document the visit to your doctor. 

Therefore, medical coding is the translation of medical reports into a short code used within the healthcare industry. This helps summarize otherwise cumbersome medical reports into efficient, data-friendly codes. While complex and detail-driven, coding really comes down to knowing how to navigate the three main code sets: CPT, ICD, and HCPCS. These code sets help coders document the condition of a patient and describe the medical procedure performed on that patient in response to their condition.

The entire world depends on medical coding as defined by WHO (World Health Organization). We use it to better understand the overall health and wellness of people around the world. In the US we also use it to help providers get reimbursed for their services by medicare and other insurance companies. Where did it start, and how did it come to be? 

Infographic: Medical Coding History Timeline

Origins can be traced back to John Gaunt a physician from London who lived in the 1600's. He developed a system to document what was happening to his patients to better understand the mortality rate in England. The study became known as "The London Bills of Mortality". Initially the bills of mortality was to determine the reason children under 6 years old were dying.  

Medical coding can be full of unknown terminology and TLA's (three letter acronyms). It can be daunting and often times overwhelming to have a slew of words coming at you that might sound like Mandarin to an unfamiliar ear.  Our staff’s experience combined would probably equal centuries of medical coding knowledge, yet at times we will still hear a word that we are not familiar with.  We thought it would be useful for industry peers to create this resource full of medical coding vocabulary and key terms. Without further ado let’s get started: 

Clinical Modification

This designation, created by the National Center for Health Statistics, is added to the ICD code sets when they are implemented in the United States. The ICD-10 code set went from 14,000 codes to over 68,000+ codes with the transition to ICD-10-CM. The term "CM" added to the end stands for "clinical modification". 

The concept is quite simple: Determine what is wrong with the patient, and then document what you do about it. As simple as it may seem, providers all across America struggle with this highly impactful piece of the business. Revenue and regulatory compliance are two of the most discussed topics of impact.  While those two factors are of the upmost importance submitting clean claims remains one of the most important parts of any providers clinic. 

Where do you start whether you are a physician, administrator, or an integral part within the revenue cycle?  Below are three very important points to consider:

It seems like a simple concept:  Document what is wrong with the patient, and what you are doing about it.  Yet, despite clear and highly visible impacts to any healthcare organization, the war for improvement rages on in every provider office across the country.  The two hot spots most often acknowledged are impacts to revenue and regulatory compliance.  We will talk about the importance of those factors – but I would also submit that clean and actionable patient information is a critical piece of our nation’s healthcare strategy.  More on that in a bit.

Where do you start whether you are a physician, administrator, or cog in the revenue cycle machine?  Here are a few key strategy points to consider:

What does success in 2018 look like to you? Your probably not thinking about taking your single provider practice and expanding into 100 physicians. You probably aren't even thinking about doubling growth. Most people are looking for some steady improvement over 2017. Good news, that is extremely feasible with just 5 simple improvements. 

When exploring the option of outsourcing any or all of your revenue cycle processes there are many factors to consider.  There are at least a thousand ways to dissect this, and many positive outcomes and advantages.  There are certainly pitfalls to avoid, we will start with a few of the many misconceptions relating to hiring a revenue cycle management company.

Here are 7 misconceptions about outsourcing in healthcare:

Misconception #1: Your Reimbursement Will Drop if you Outsource

$25 to rework a claim? That is right, according to an MGMA Connection article it will cost the provider $25 on average to rework a claim. That might not sound like much, but think how many denied claims you receive every single day, month after month. So not only are you not getting money from the insurance company, you are having to pay $25 to rework it in the hopes that it will not get denied again. This is a cash flow nightmare for any practice. This is why we are writing our 5 tips to reduce denials. 5 simple improvements that can save you hundreds of thousands of dollars over the years. Without further ado:

Tip #1 Documentation Errors

in the fiscal year of 2013 CMS RAC auditors identified and corrected $3.75 billion in improper payments. Perhaps you were part of that, or perhaps you will be part of it this year, hopefully not! Simple documentation errors lead to poor coding which inevitably means either denied claims or low reimbursements. Think of this common error. 

Your medical practice is about healing patients, but it is still a business. To stay afloat, medical practices must rethink their business models. The tech revolution has transformed healthcare. If physicians don’t embrace new technology, they may miss out on untapped revenue. Here are five ways to boost your practice revenue.

1) Streamline Collections

If you have uncollected bills or spend too much pursuing late payments, your collections process needs an overhaul. Create a more focused system to boost your bottom line, and keep more liquid capital in practice accounts. Leveraging mobile tech and making full use of ICD-10 for your medical coding and supplemental medical coding is a good place to start.

2) Outsource Billing

Outsourcing billing may seem like a huge investment, but it can enhance your profit margins. Many doctors report outsourcing their billing process saves overhead costs and the headache of processing claims in-house. It makes good business sense- billing outsourcing firms have to be competitive- so it only stands to reason that doctors would use to improve their revenue cycle.

3) Monetize Checkup Calls

Checkup calls and emails with patients are becoming increasingly more common, and frequently go unbilled. Consider replacing some follow up calls with online video visits. Patients will happily pay for the convenience. Many patients are more enthusiastic about this option than they are about traditional appointments, and it’s a great way to increase the volume of visits.

5 a.m. hits like a semi truck when my alarm goes off. I begrudgingly get out of bed and begin my morning routine. Being "healthier" this year certainly feels a lot more like being "tired." Once I get my gym clothes on, I feel my way down the dark staircase to my kitchen and pull out my pre-workout supplement. 

Pour

Mix

Drink

Once this 3 step process is complete, I instantly feel a boost. My body responds and I know its time to get to work. I take this supplement combined with protein in the mornings to get the fitness results I want. Medical coding like my new years resolution can offer an extremely positive results on your practices financial outlook, or it can be bleak and discouraging. Lets take a look at how to boost your medical coding with supplements.  

Temporary Coding

Temporary medical coding is a great way to help keep things moving when a coder, office manager, biller, etc. is out on leave or vacation. July and December see an extreme uptick in employee vacation days, leaving administrators with a pile of coding work that needs to be done in order for claims to be submitted. Inevitably the large stack gets coded with a lower quality and higher denials as the recently returned personnel doing the coding is trying to play "catch up" in order to get back to his or her normal routine. Playing catch up is never a good thing when it comes to revenue. Temporary coding is a supplemental medical coding practice that can help providers maintain a level of excellence when coders are not able to perform due to leave.