Introduction:

Clinical IT solutions can go a long way in reducing overall costs and increasing efficiency in healthcare. Ranging from hospitals to independent clinics, all healthcare organizations place cost efficiency and service excellence among their priorities. Automation of clinical IT systems can be critical to achieving these priorities. The crux of automation can be defined as the deployment of IT systems that control functionalities and reduce human involvement in the organization of data and monitoring of services. Automated IT systems have been maximized in other industries for many years now. However, the healthcare industry is now turning to these solutions for increased efficiency. The financial department benefits significantly from healthcare software product development within the healthcare industry.

Through clinical coding solutions, automation reduces the burden on the administrative staff of redundant jobs and increases focus on intelligent and satisfying arenas of work. The automated processes take manual data entries, and medical staff can focus on intelligent analytics and supervisory processes. Clinical management solutions can be incorporated into custom healthcare software solutions to increase efficiency across the entire lifecycle of caregiving. Specifically, medical coding software solutions simplify the financial processes between patients, providers, and payers. According to a recent study, almost 95% of healthcare providers display a keen interest in adopting medical coding solutions.

At OSP, medical coding and verification, especially clinical labs, were one of our client’s main concerns, resulting in high claim denial rates and revenue loss. To address this challenge, OSP’s custom-made claims prediction software solution solved the client’s challenge of coding and verification and boosted the company’s productivity. The system’s highly accurate and efficient prediction of the possibility of claim approval and the estimated settlement date and amount directly translated into a significant increase in revenue.

Let’s check out what medical coding is and why it is important.

Importance of Clinical Coding Solutions

Medical coding is used to transform healthcare diagnoses, procedures, and provided medical services into universal medical alphanumeric codes. It enables providers to bill the insurance company accurately. This, in turn, gathers valuable information on medical procedures, treatments, prescriptions, and trends in patients’ conditions.

Such information gathering is required for accurate billing and reimbursements. The introduction of the Affordable Care Act (ACA) has made the coding process even more important. One important aspect of medical coding is ensuring that patients receive a correct diagnosis.

With this, let’s discuss other factors that make the clinical coding process vital for the healthcare industry:

1. Coding Update

Medical codes change regularly and the introduction of telehealth solutions during the pandemic period sets one example of a new way of coding medical visits. With medical coding software development, one can efficiently adopt such changes.

2. Fewer Claim Reimbursement

The last decade has seen reduced reimbursements by payers. This happens when claims are denied due to errors in clinical codes or other reasons. However, such errors can be prevented by using automated clinical coding solutions. Medical coders can use medical billing and coding software to address coding errors and boost revenue cycle management.

3. Changes in Delivery Models

The ever-changing delivery models like medical procedures, surgeries, and testing are another important reason why the healthcare sector requires automated coding software. Outpatient settings and ambulatory surgery centers are also becoming increasingly common, emphasizing coding accuracy. Medical coders must be aware of such codes and help achieve efficiency in reimbursement.

Automated vs Autonomous Medical Coding

With every passing day, the healthcare industry is evolving and the need for precise and efficient medical coding is becoming paramount. Traditionally, human medical coders were solely responsible for assigning appropriate codes to the provided medical services. But today the advancement in medical coding technology has introduced powerful coding solutions like computer-assisted coding (CAC), automated medical coding, and autonomous medical coding.

Automated Medical Coding

In the automated medical coding process, artificial intelligence (AI) extracts appropriate information from the provided clinical documentation and suggests standardized, relevant codes like CPT, ICD, and HCPCS. It assists the human coders in assigning diagnostic and procedural codes. These codes are further used for billing, reimbursement, efficiency, quality assessment, etc. In automated coding, the human coders are actively involved in the clinical coding process. These coders use their expertise to accept, modify, or even reject the automated suggestions.

Autonomous Medical Coding

In autonomous medical coding processes, more advanced levels of next-generation tools like machine learning (ML) or artificial intelligence (AI) are used. Here autonomous medical coding tools leverage advanced algorithms and other technologies to analyze, interpret, and extract relevant information to generate accurate clinical codes without direct human intervention. It utilizes deep learning models and advanced algorithms to analyze clinical documentation and assign appropriate codes. They don’t depend on human coders once they are trained and deployed and keep abreast with the coding systems through self-learning mechanisms.

So, what is the difference between the two? Let’s discuss.

Difference Between Automated and Autonomous Medical Coding

Here’s how they differ:

1. Level of Automation

Automated coding involves software assistance to human coders, whereas autonomous coding relies on machine learning (ML) or artificial intelligence (AI) systems to independently perform coding tasks.

2. Human Oversight

Automated coding requires human oversight for decision-making, whereas autonomous coding operates with minimal or no human intervention once deployed.

3. Complexity and Capability

Automated coding systems are dependent on human expertise and inputs, whereas autonomous coding systems are more sophisticated and capable of handling complex coding tasks independently.

Challenges of Medical Coding in Healthcare

The medical coding process plays a pivotal role in patient care episodes, administrative processes, and financial realms. Hospital coding is not just an administrative task, it is a fundamental pillar of the revenue cycle management process.

No doubt, clinical coding workflow is a complex and tedious process and is fraught with challenges.

1. Insufficient Documentation

Insufficient documentation is one of the clinical coding challenges that occurs due to incomplete or inadequate information on patient records. Unclear terminology, incomplete physician notes, or missing details can create disruptions in converting patient care into appropriate alphanumeric codes. This challenge often arises due to overburdened or rushed professionals.

Healthcare coding software can efficiently handle such issues. It can provide consistent documents and standardized templates and help avoid communication gaps between coders and clinicians. The software simplifies clinical coding workflow, helping in accurate code assignment and preventing claim denials and reimbursement delays.

2. Coding Inaccuracy

Coding inaccuracy usually occurs due to the wrong use of modifiers, missing implants, not coding bilateral procedures, or any discrepancies in mentioning alphanumeric codes to healthcare diagnoses and procedures. Other reasons could be the misinterpretation of medical records, insufficient documentation, or the coder’s oversight during the complex coding process. Sometimes, changed coding guidelines may also cause coding inaccuracy.

Introducing healthcare coding systems into your workflow can ensure that medical coding and billing are performed with utmost precision. The software’s error-checking features prevent repercussions of coding inaccuracies, reduce claims denial, and boost the flow of revenue.

3. Frequent Coding Updates

The healthcare industry is experiencing technological advancements, updates in healthcare regulations, and the inclusion of new medical procedures, diagnoses, and guidelines. Such changes will undoubtedly update the medical codes. Keeping up with these changes requires continuous education and adaptation by healthcare professionals. Failing to do so may result in coding inaccuracies.

To overcome this challenge, medical coding systems software solutions are required. The automated coding software can update its code set manuals yearly, preventing coding and billing errors. It further stays abreast of changes, accurately assigns diagnostic and procedural codes, and ensures proper reimbursement, compliance, and patient care documentation.

4. Overcoding or Undercoding

Both overcoding and undercoding may result in potential fines and penalties. Overcoding refers to allocating medical codes that exaggerate the complexity of the services delivered to the patients, while undercoding means assigning only a few codes or oversimplifying the codes. To avoid this issue, it is better to review the provided documentation briefly, consult with auditors, or even seek clarification from the healthcare providers.

Otherwise, can use medical coding technologies to streamline the coding process. Coding medical software solutions can better analyze the documents and include codes for each procedure and service rendered and help manage a patient’s treatment history and optimize revenue.

Benefits of Medical Coding in Healthcare

These are a few benefits of clinical coding solutions in healthcare:

1. Increased Revenue

Medical coding and billing in healthcare ensure that the providers are reimbursed accurately for the provided services. The software for coding automation can boost the hospital management system. This software can optimize revenue capture, ensuring that all billable services and medical procedures are appropriately coded. A clinical coding compliance system helps identify the overlooked services, ultimately leading to improved financial performance, cash flow, and increased revenue.

2. Compliance Assurance

Clinical coding compliance is essential for maintaining accuracy and transparency in medical coding. Software for clinical coding solutions ensures adherence to regulatory standards, minimizes risks and improves healthcare quality. It helps healthcare organizations safeguard against fraud, legal penalties, and billing errors and fosters trust among patients and stakeholders. Moreover, compliance assurance develops data integrity, facilitating informed decision-making and research.

3. Improved Reimbursement

Clinical coding tools ensure fair compensation for healthcare services rendered. It encourages financial stability for providers, reduces administrative burdens, and streamlines billing processes. Medical coding and verification software helps in medical claims management, improving the financial health of healthcare practices. Clinical coding solutions facilitate accurate coding, ensuring that claims are processed correctly and reducing the risk of claim denials or payment delays.

4. Cost Savings

Clinical coding services decrease billing errors and claim denials, minimizing revenue loss and administrative expenses associated with rework. To make the most of coding technology solutions, organizations can outsource professionals or have in-house medical coding teams. These professionals use automated medical coding solutions for timely reimbursement, improving cash flow and financial predictability. It enhances operational efficiency, and saves time and resources for healthcare organizations, ultimately helping in cost savings.

5. Accuracy

Automated clinical coding software can significantly boost accuracy in medical billing and coding. Clinical coding solutions ensure detailed observation of provided documentation of patient diagnoses and procedures and assign accurate medical codes. It increases the chances of faster approvals, fewer denials, and timely reimbursement. Also, investing in medical coding apps can enhance communication among providers and coders, preventing the possibility of misconception.

Integral Features of Clinical Coding Solutions

Below mentioned are the features you must have in your clinical coding solutions:

1. ICD-10 Integration

Medical coding and billing are processes that are prone to consistent errors due to the constant updates and changes in medical codes. Revenue cycle management is adversely affected by rejected or denied claims, usually resulting from inaccurate coding. The U.S. medical coding system is constantly changing to add to the dilemma. The COVID-19 period witnessed unprecedented coding changes. Therefore, medical coding and compliance solutions need to be designed toward automated adaptability of ICD-10 and the soon-to-be-introduced ICD-11 codes. Implementing software that updates with evolving ICD coding systems has become essential.

2. Adaptability

Apart from the nature of consistently evolving codes, the pandemic has placed a heavy strain on healthcare organizations. Advanced technologies, applied to healthcare management, can reduce this burden considerably. It is no wonder that healthcare organizations are looking to automate tasks related to finances and billing. With flexible medical billing solutions and coding software, data is extracted from medical records to enable further coding and streamlining or avoid errors. Medical billing companies are spared a heavy burden when the software for medical coding and verification is equipped with efficient and accurate coding methodologies. The healthcare revenue cycle management process is instantly uplifted through fewer errors, which translates to higher profits.

3. Claims Management

Coding medical software solutions play a vital role in countering the rising medical claims denial rate and adherence to stringent federal regulations. Healthcare automation solutions can offer tailor-made medical claims processing services to seamlessly integrate multiple complex systems, platforms, and manual processes into the medical claim processing workflow throughout the life cycle. Medical coding systems software solutions should be outfitted with intelligent integration capabilities that perfectly synergize with existing administration systems. By incorporating medical claims processing software solutions there can be a check for coding and billing errors, pre-adjudicate the claim for accuracy, and receive denied claims and re-adjudicate them effectively.

4. Cloud-based Hosting

Efficient coding systems in healthcare involve financial reports, patient documentation, and claims reporting as core components that can be integrated through healthcare cloud solutions. Good medical billing and coding software should be able to access and update these reports in an automated fashion. Robust reporting technologies allow seamless workflow between caregiving and billing, providing an all-rounded efficiency. Ideally, a cloud-based solution that interconnects all patient-related information is an efficient methodology for consistent data access.

5. Advanced Security

Healthcare coding software requires stringent quality and security checks. Clinical coding systems of the healthcare industry must look into the security requirements relevant to it, specifically with the security of financial information. During the medical coding software development process, keen attention needs to be paid to the applicable international and state laws. Healthcare software deals with sensitive patient health data, and therefore, developers need to ensure that security provisions are in place to ensure no breaches. If opting for integrated healthcare solutions, close attention should be paid to all-rounded security and quality standards.

6. Data Efficiency

Whether it’s medical billing and coding, medical billing codes, online doctor appointment scheduling, healthcare data integration, or electronic data exchange, efficient clinical coding software solutions should prioritize data efficiency. Another trigger for medical billing errors is inaccurate and insufficient data collection and usage. Common medical billing mistakes occur when patient information is not collected comprehensively, and clinical procedures are not filed in a timely and accurate manner. Practice management solutions can offer comprehensive data collection services for holistic data within medical billing software. Improper medical coding can be drastically reduced when patient data is collected efficiently and used toward medical billing codes. Finally, accurate and complete data erases the possibility of duplicate claims, which can further delay payment processing. Automated information filling, such as social security numbers, demographic codes, etc., can speed up the medical coding process and procedures.

7. Editing Features

Clinical coding software should offer interactive and powerful editing features to enhance performance. The application of medical informatics can allow the tracking of every single claim transmission and verify its successful submission. Beyond this, medical coding companies can incorporate customized interactions, wherein questions can be answered, coding can be rectified, leads can be addressed, and coverage issues can be identified. Finally, automated medical coding solutions allow monitoring and tracking of each stage of a medical claim or batch from first logged to posted payment.

8. Dynamic UX/UI

Clinical coding services are directly dependent on patient appointment scheduling details to ensure the accuracy of medical billing codes. Medical coding and billing can be significantly simplified through access to patient inflow, treatment details, appointment types, and revisits. Robust clinical coding solutions are integrated with remote health monitoring systems that depend on each other for accuracy. An easy-to-access interface, which shares a common platform for scheduling and billing, is the ideal component of an efficient healthcare payment system.

9. Compliance

You can safely call this feature the lifeblood of clinical coding solutions. Compliance strength should take precedence in medical coding services among the many features. Without compliance embedded into hospital coding or any other form of medical coding, the risk of running into a lawsuit is high, and this can cause a harsh blow to healthcare RCM. Manually keeping up with updated medical laws is relatively difficult. Therefore, automation within the compliance aspect of your software is essential for maintaining HIPAA compliance standards.

10. EHR Integration

A centralized database of patients has its advantages, but integrated health information systems work better for hospital coding. The benefits are much greater when the clinical coding software has instant and uninterrupted access to the updated patient database through integrated health systems. Hospitals and other healthcare organizations must ensure that EHR/ EMR systems access is given to the medical coding and billing department to boost the revenue cycle for healthcare and offer holistic patient engagement systems. Finally, it allows access to medical records, insurance eligibility, Medicare coverage, etc.

Latest Trends in Medical Coding

The future holds great opportunities for medical coding. The growing amount of medical data demands more proficient medical coders who can use their knowledge and expertise to help organizations boost their cash flow. With the introduction of new technologies, medical coders will need to be updated on the latest coding systems to use them effectively.

Let’s discuss the latest trends in Medical Coding:

1. Rise of Autonomous Coding Technology

As already discussed in our above paragraphs, autonomous medical coding technology is powered by AI and ML and requires less to no human intervention when assigning codes. It uses advanced algorithms to analyze vast amounts of medical data and accurately assign the appropriate standardized codes to medical procedures and diagnoses. With the passing of time and proper training, this technology can revolutionize the medical coding process.

2. Telehealth

Telehealth uses digital information and communication technologies to provide healthcare services remotely. Telehealth services have involved adjustments in medical billing and coding practices and the COVID-19 period is the best example that has shown its importance in healthcare delivery. Health professionals must navigate codes specific to virtual visits and telehealth services, as it is growing the prominence of remote patient monitoring.

3. Value-based Care

Value-based care is all about providing quality care and improving patient outcomes. The rising adoption of value-based care calls for a change in the approach to medical coding and billing. Medical coders and other related professionals need to align their coding practices with value-based care initiatives. Proper clinical coding solutions can improve patient outcomes and offer financial sustainability. They can further streamline the billing process, lower the likelihood of improper billing, and help prevent payment delays.

Conclusion

Medical coding companies are faced with the constant irk of incorrect coding. The complex system of medical bills is owed to the complexity of accurate coding. Keeping up with updated codes and ensuring and double-checking the patient’s clinical processes to match the proper codes is no ordinary task. Medical billing services, very often, face the issue of complacency. Codes are not double-checked for accuracy, and old codes result in denied claims and reduced cash flow. Clinical coding solutions and automated coding software can greatly assist in mitigating medical billing errors. As medical billing companies attempt to streamline their services, robust coding software is the best way to stay ahead of the game.

OSP is a trusted healthcare software development company that delivers bespoke solutions as per your business needs. Connect with us to hire the best talents in the industry to build enterprise-grade software.