YES Reduces Client’s Radiology Coding Backlog by 86 Percent
Accurate and timely coding is essential for hospitals to maintain financial stability and operational efficiency. However, coding backlogs can impede these processes, leading to delayed reimbursements, increased claims denials, and potential revenue loss. This article reviews a recent case study conducted by our Outpatient Coding and Auditing teams, focused on reducing a client’s radiology coding backlog and streamlining internal processes.
Addressing the Client’s Challenges
The case study spanned 15 months and focused on coding encounters from the client’s freestanding outpatient radiology imaging centers. The client faced a coding backlog of over 3,500 encounters, driven by the retirement of experienced coders and a need for qualified replacements. The objectives were to reduce the backlog to 1,000 or fewer encounters per day, establish standardized procedures, and develop a plan for transitioning coding operations back to the client’s team.
In addition to the backlog, we identified the need to address the manual process of coding for the Merit-based Incentive Payment System (MIPS). MIPS coding requires coders to manually recall, research, and include MIPS measures for specific CPT radiology codes, which, when accurately coded, can result in increased reimbursements for providers1. We developed an automated alert within our coding system logs that flagged the need for additional MIPS measures when our YES consultants entered specific CPT codes into our internal coding log, simplifying the process for our team, reducing time spent on researching these codes, and eliminating the likelihood of errors or omissions.
The key objectives of the case study were the following:
- Address the high coding backlog and provide coding coverage until the client hires enough trained coding staff.
- Establish and implement a plan to streamline internal coding processes to prevent future case build-up.
- Create an automated process and structure to flag MIPS codes and incorporate the tool in daily coding operations.
- Develop a phase-out plan to seamlessly transition all coding operations to the client’s coding team.
Results of the Radiology Coding Backlog Case Study
During the case study, our team members set out to prove that outsourcing the coding backlog and implementing efficient processes could address the challenges faced by facilities and provide sustainable solutions for the future. The study aimed to demonstrate improved outcomes, reduce the reliance on external partners, and simplify the coding process for the required MIPS measures.
To address the coding backlog effectively, the study employed a multi-faceted approach. Additional auditors, coders, and team members were brought in to supplement the efforts of YES consultants. Internal coding manuals with facility-specific policies and specialized radiology training were provided to enhance accuracy. Tracking logs and a structured action plan was developed to distribute coding assignments. The implementation of automated alerts simplified the MIPS coding process, reducing research time and eliminating errors.
After 15 months of providing coding support, the backlog was reduced by 86 percent to 500 encounters per day, meeting the target goal of fewer than 1,000 encounters. The implementation of internal coding manuals, specialized radiology training, and a structured action plan played a vital role in efficiently addressing the backlog. An automated alert for MIPS measures within the coding system further enhanced accuracy and compliance. The study successfully achieved its objectives, and the client’s in-house coding team was fully prepared to take over coding responsibilities.
Next Steps for Your Facility
Hospitals should develop standardized procedures in the event of staffing shortages in order to prevent an inflated coding backlog. The client should continue to ensure that they have a sufficient number of qualified coders to handle the coding workload. Regular evaluation of staffing needs should be conducted to prevent future backlog build-up.
To assess their personnel needs, the client should examine their production data to determine how many encounters per hour can be coded. Then, they can calculate the number of FTEs needed based on the encounters in the queue.
Moreover, the client should explore integrating advanced coding technologies, such as automated coding software, to further streamline manual processes and reduce the risk of errors.
We recommend the client establish standardized coding processes, including the development of coding manuals and guidelines tailored to their specific facility. These standardized procedures will promote consistency, efficiency, and accuracy in coding practices.
Based on the case study findings, we recommended the client and facilities in a similar situation:
- Maintain adequate staffing and evaluate personnel needs regularly to prevent a coding backlog.
- Streamline manual coding processes through the use of automated technologies.
- Develop facility-wide guidelines to standardize coding processes.
Interested in Learning More?
We provide the complete case study to clients, partners, and upon request. To request access to the entire case study, please send your name, company, title, and contact information to firstname.lastname@example.org. Download an Executive Summary of the case study findings.
- Understanding Medicare’s Merit-based Incentive Payment System (MIPS). (n.d.). Retrieved from American Medical Association: https://www.ama-assn.org/practice-management/payment-delivery-models/understanding-medicare-s-merit-based-incentive-payment