The Specter of the Pandemic on Healthcare System
The COVID-19 pandemic has altered lives and impacted our general well-being as well as the economy. Above everything, this is an unprecedented health crisis that has endangered human lives and strained our healthcare resources to its limit.
The healthcare system’s vanguard role in the fight against the COVID-19 crisis has made it an epicenter of impact. Due to the high communicability of the virus, hospitals and health centers are being feared as a hotbed of disease-spread. This has resulted in a steep decline in hospital visits with some healthcare providers reporting a 70-75% drop in overall service volumes. According to the American Hospitals Association, the total losses for the nation’s health systems and hospitals are estimated to hit a staggering USD 323.1 billion by the end of 2020.
This debacle has prompted doctors, providers, and practice managers to think critically on ways to provide their patients with quality care at a reasonable cost. At the same time, healthcare organizations need to address the pressing concern of a stagnating revenue stream in a high deductibles private insurance landscape.
In-House Coding: Outlining the Challenges
The operational and financial burden of the pandemic on the healthcare providers have laid the focus squarely on billing and coding procedures. In today’s value-based care ecosystem, medical coding is the key to extracting billable information from patient records into claim submissions and reimbursements. Accurate and comprehensive coding practices are, therefore, essential in maintaining a healthy revenue stream. Any slip-ups in this regard can have significant financial ramifications.
Maintaining in-house coding even though critical, can often turn out to be a cumbersome affair. The primary challenges are:
- Liabilities: Any neglect of the stringent coding procedures can have an adverse impact on the organization including reimbursement delay or denial, lengthy processing timelines, and audit or over-coding charges from insurers.
- Management Issues: When maintaining in-house coding teams, even the absence of a single member can have a drastic impact on coding volumes with the operations stalling affecting the cash flow.
- Additional Workload: In-house training of coders can add on to the already strenuous initial workload of the employees. This may lead to errors and omissions which can prove costly.
The cost of maintaining a team of in-house coding professionals varies with the type and size of the practice. Usually, the cost per coding professional is lower in smaller practices of up to 10 physicians compared to a large practice or a full-fledged health system. However, the average yearly salary of an in-house medical coding professional can range anywhere from USD 48,000 to over USD 57,000. An investment that can be huge, especially for smaller organizations.
The cost of in-house coding can be broken down into three major expense models.
- Internal HR Recruitment: This includes all internal costs of employment such as salary, employment taxes, Medicare tax, training, and vacation days.
- Staffing Agency: In case your practice engages with a staffing agency to hire skilled coding professionals, you will need to follow an expense structure similar to the in-house recruitment model along with a staffing agency commission
- Outsourcing: This is the least expensive of the three models. However, you will still need to bear the outsourcing costs.
The pandemic has added several layers of complexities over these existing challenges. There has been a slew of coding guidelines planned/released in line with the coronavirus outbreak and subsequent medical care which adds to the complexity of an already onerous procedure. For telehealth and telephone visits, there have been several challenges including inconsistent payer rules, general lack of pay parity and accuracy, and documentation challenges.
Coder Responsibility Expansion
As an essential component of the revenue cycle in a value-based care system, medical coders today are benchmarked on four key metrics– charts reviewed, claims coded, claims submitted, and denials appealed. However, their traditional role is changing rapidly and the spectrum of responsibility is expanding to accommodate several business-oriented responsibilities such as:
- Appealing Denied Claims
- Conducting audits/ internal review
- Filing Claims
- Performing compliance-related activities
- Querying clinicians on documentation
It is, therefore, hardly surprising that healthcare organizations are up against a stone wall in terms of maintaining a robust revenue through diligent coding. In fact, inaccurate coding practices are the primary cause of claim denials and results in large financial repercussions for hospitals and other healthcare institutions and hampers the overall quality of service (QoS). But how much is coding responsible for denials? And how heavily are hospitals bleeding cash from inaccurate coding? We will explore the answer to these questions and more in our next blog.
Why ezDI: Partnering for Success
Healthcare organizations can leverage technological innovations to achieve efficacy and efficiency with their healthcare coding. Choosing the right CAC software can improve the accuracy, efficiency, and productivity of the coders by empowering them to make faster and better-informed decisions. This can streamline coding programs and add value to revenue streams. Partnering with an experienced and valued technology provider can go a long way in countering challenges.
And here is where ezDI can help. As the only fully integrated, born-in-the-cloud, AI-enabled technology provider ezDI’s comprehensive suite of CAC solutions can help healthcare institutions improve their coding and documentation process to counter the challenges posed by the COVID-19 disruption.
For a more detailed exploration of In-House clinical coding in the new normal, read our eBook here