Healthcarercm

  With the advent of autonomous coding technology, the future of medical coding is undergoing a significant transformation.  Autonomous coding technology  is having a profound impact on the revenue cycle, including improving cashflow, maximizing revenue, and enhancing patients’ financial experience. The Current State of Medical Coding Medical coding  is integral to healthcare administration, billing, and reimbursement processes. It involves assigning specific alphanumeric codes to describe patients' medical conditions, diagnoses, procedures, and treatments. These codes help ensure accurate claim submissions, appropriate reimbursement, and streamlined communications between coders, CDI specialists, and physicians. Manual medical coding processes are prone to human error, inconsistencies, and inefficiencies, which leads to coding inaccuracies, delays in claim processing, and potential revenue loss for healthcare organizations due to underpayments and potential fines du...

  Patient access  marks the start of the patient journey and produces a lasting impact on the individual patient’s experience. An effective process ensures timely access to necessary medical services and efficient operation can have a significant impact on the financial performance of healthcare providers in securing appropriate payments for the patient access services they provide. However, managing processes such as  appointment scheduling ,  insurance verification ,  prior authorization , and collecting co-pays and deductibles is not without challenges. A poorly functioning patient access system can lead to  lost revenue  and the costs of rework, denials, and appeals can add up quickly and further erode margins. In fact, approximately 50% of denials point back to  front-end revenue cycle management (RCM) issues . Overcoming patient access services challenges Common challenges healthcare providers face when seeking to provide a synchronized financial...

Labor shortages present significant challenges for healthcare organizations, which have been intensified by the COVID-19 pandemic. Nearly two-thirds of healthcare facilities are understaffed, resulting in decreased data quality, slower claims processing, increased claim denials, increased workload, burnout among existing staff members, and higher turnover rates. An AHIMA survey report as of October 1, 2023, indicates the U.S. experienced a 66% shortage of health information professionals (HIM) for the last two years due to the great resignation, an increase in growth demand, and an increase in the aging population in the U.S healthcare industry. Data from the Bureau of Labor Statistics (BLS) estimates that  healthcare jobs are expected to grow 13%  through 2031. Approximately 83% of HIM staff are distributed between revenue cycle management (RCM), coding and billing, and medical record administration, suggesting an even higher concentration of a shortage of staffing in these a...

Accuracy and efficiency of coding and documentation are crucial for successful revenue cycle management (RCM) and to ensure optimal reimbursement. Applying technology to   mid-cycle RCM   operations enhances the quality of   clinical documentation improvement (CDI)   and coding processes. This article explores the tools and strategies that are reshaping the way healthcare organizations enhance documentation quality, streamline coding workflows, and maximize revenue capture. Technology in Clinical Documentation Improvement Worklist Prioritization Effective worklist prioritization strategies are necessary to maximize the efficiency and impact of CDI efforts. Traditionally, a discrepancy in the number of CDI specialists compared to the overall patient population has led to the adoption of a sampling approach to documentation, where only a subset of patient records is reviewed. This method, however, results in a considerable number of missed opportunities for queries, as...