Unlike other service industries, healthcare has a complicated medical coding system for the services provided. For example, in accounting one hour of service is a specific cost. A simple tax return is another specific cost. In healthcare, it is rare that we can easily quote that a service will be a specific cost. This is due to the way that we are required to code the services we provide and then bill for them. The rules are dictated by outside agencies on how providers document patient encounters in a specific way, code the encounter a certain way, and then the payers may contradict that. Just another fun day in the world of healthcare coding and billing!
To optimize the coding step of the revenue cycle, medical practice administrators must
- determine who will be responsible for knowing the documentation requirements for the medical codes being used,
- assure that the documentation meets these requirements and
- that the code combinations also meet insurance regulations.
Once responsibility is assigned, how each of these steps will be accomplished must be determined.