As the focus on value-based care intensifies across the US, the adoption of digital tools and technologies have witnessed significant growth in the healthcare industry. However, despite the rapid rate of digital adoption in the US healthcare sector, hospitals and clinics often struggle to overcome siloed coding workflows. Let us take, for instance, facility coding and professional fee coding for outpatient (O/P) services; both of which have traditionally used separate coding platforms and resources to capture relevant codes.
The disparity in the processes often leads to redundancies in already slow, paper-based manual practices. The negative impacts of this include improper/double coding, untimely filing of claims, and high denial rates. As a result of these inefficiencies in the O/P reimbursement process, the US healthcare industry loses close to a staggering USD 54 billion each year.
To plug the revenue leak, health systems are faced with the need to reimagine these disparate processes and workflows. This not only involves reducing costs but also raising coder efficiency and output.
Single-Path Coding: The Opportunities and Challenges
As outpatient volumes continue to grow (amidst reducing admission volumes), there is a pressing need to adopt a more efficient coding workflow across healthcare institutions. This is where single-path coding comes into play.
By performing both the facility coding and the professional fee coding for the same patient account by the same coder in the same workflow, single-path coding eliminates duplicative processes and optimizes productivity. Moreover, with the right technology to augment the ability of one coder to assign both professional and service codes, hospitals and clinics can shatter the barriers between facility and professional coding through a single point of access.
Especially in outpatient settings, an effectively designed single-path coding practice can generate significant benefits for care providers.
- Eliminates duplicate processes: When a single coder is focused on coding both professional and service codes for a single account, chances of duplicate codes being made goes down significantly.
- Improves productivity: A single point of coding eliminates the need for work to be spread across multiple coders. This increases overall productivity and lowers costs by a significant margin.
- Eradicates discrepancies: Variances in codes of both professional and service claims can be effectively eradicated. With a single coder assigning codes, the risk of having two different codes ascribed to the same documentation is eliminated.
- Reduces claim denials: Eliminating variances stemming from multiple disparate coding workflows ensures that claims rejections are reduced by a significant amount.
The benefits of single-path coding are significant and are encouraging enough for most healthcare organizations to adopt the practice. However, when it comes to implementing single-path coding, there are several challenges that healthcare providers need to understand and overcome. These include:
- Time and expenses: Training coders on modifier use, technical vs professional components, and payor guidelines can be an expensive affair, both in terms of time and capital.
- Finding experienced coders: One of the biggest issues facing healthcare organizations is finding coders with the right experience, variety, reliability, and resourcefulness.
- Stakeholder management: There is often a discrepancy in understanding the coding process across the multiple functions involved in the revenue cycle management process. Even organizations that have the best coders, systems, and workflows in place can stumble if all stakeholders are not in alignment.
- Finding the right technology: Identifying and implementing the right platform that can accommodate specific business needs requires a comprehensive understanding of how different claims and coding workflows can operate in unison, and what platforms can best facilitate that process.
Choosing the Right Technology
While finding the right coders and creating a customized workflow can be achieved by taking commonly known measures, the foundation for implementing single-path coding is the right technology.
When choosing the right platform to meet your single-path coding needs, there are a few key considerations to look out for. These include:
- The ability to auto-suggest accurate codes
- Strong underlying AI and Natural Language Processing models
- Assistance and continued education for coders
- The ability to interoperate with the professional side as well as the facility side of billing.
For instance, EZDI’s NLP-powered Computer-Assisted Coding (CAC) software is a comprehensive solution that provides a high-performance platform to address your single-path coding requirements. Intelligent CAC worklists allow chart types to be matched to coders based on their skills and work availability. Furthermore, accurate coding suggestions automatically select the right E&M codes and provide predictive suggestions based on pre-established rules and insights.
By leveraging EZDI’s CAC software, healthcare facilities can ensure enhanced workflows, revenue management, and overall coding productivity on a single platform. The primary improvement opportunities that you can expect from EZDI’s solutions include:
- Cost efficiency
- Accuracy improvement
- Great coder satisfaction
- Reduced denials
Amidst the changing healthcare landscape, the necessity and challenges of single-path coding can not be overstated. However, EZDI’s complete suite of revenue cycle management solutions ensures synergy across the three pillars of people, process, and technology. This allows care providers to ensure the ideal single-path coding framework that meets the needs of a value-based healthcare ecosystem.