Coder-Driven Improvements to the Revenue Cycle: Reduce Denied Claims, Streamline Claim Submission Process, & More

Coder-Driven Improvements to the Revenue Cycle: Reduce Denied Claims, Streamline Claim Submission Process, & More

Financial issues are one of the biggest challenges that healthcare organizations currently face. The issues that can be detrimental to a facility’s revenue cycle include decreasing reimbursements, coding quality and accuracy issues, and increased denied claims. However, coder involvement in the implementation of improvements to the revenue cycle is an underutilized asset at many facilities.

Here are several opportunities where organizations can utilize coders to make revenue cycle improvements:

• Managing DNFB (discharged not final billed) accounts
• Engaging in a collaborative process for claim submissions
• Reducing the amount of denied claims with coding quality, accuracy, and training

Managing DNFB Accounts

A lot of factors can attribute to a high DNFB rate. Registration has an impact with insurance verification delays, ancillary departments with late charges, billing with unresolved edits, and equipment with slowness and failures. However, coding owns a substantial portion of this number.

Coders in the trenches may have a better perspective of what works and what doesn’t. Furthermore, mining these ideas is the responsibility of good leadership. Communication is a key tool in uncovering these gems, so it is essential to set up a reliable line of communication between the coding team and management where coders feel comfortable bringing these ideas to light.

Coders should receive a proper orientation to the organization and explanation of the company’s equipment and goals. Ongoing coding education will keep the coder informed. This includes, but is not limited to, the ICD-10 CM/PCS updates on Oct 1st, CPT on Jan 1st, and Coding Clinics.

Improving Productivity

Coders should receive regular reporting on coding quality and productivity. Invest in a robust analytic platform, or coding auditing partner, that can help identify areas for improvements¹. In addition, an auditing vendor, or analytics program, can automate time-consuming data organization processes, and give the organization more time to proactively enact procedures to reduce denied claims and delayed payments.

Furthermore, organizations need to praise coders for meeting goals or, if necessary, offered support and resources to improve. Share relevant company and coding information on a regular basis by memo, newsletter, blog, or other internal company communication.

Plan timely, informative evaluations for each coder, and make sure they are not cookie cutter. If a problem arises, give the coder an opportunity to improve, but if improvement is not forthcoming, termination may be necessary for both parties. In each of these activities, coders should be encouraged to communicate and contribute to the goal of lowering the DNFB rate.

Establishing a Collaborative Process for Claim Submissions

With team dynamics, the sum adds up to be greater than the parts. Attacking problems collectively will provide multiple solutions that team members can evaluate from multiple perspective. In this way, teams can identify the best solution(s).

Routine team meetings or Ad Hoc Committees are two ways to create and grow the team dynamics². Also, an agenda is an essential tool to ensure the meeting is productive and doesn’t waste time and resources³. Send out the agenda ahead of time to give the members an indication of the meeting’s subject and time to start brainstorming ideas.

To ensure participation, it is a good idea to start with a roster check and have the individuals comment on a fun topic, just to get them talking. The agenda will also set the pace for the meeting, so the team is not bogged down. In addition, it is important to keep meeting minutes and follow-up on questions and tabled items from the agenda. Also, a good facilitator will keep the discussions flowing.

Denial Management to Reduce Unpaid Claims

Denied claims either must be written off or appealed, leading to a delay of payment. In turn, denied claims negatively affect revenue. The goal is to eliminate repetitive problems and increase the amount of clean claims.

Denials should be shared with all coders, because they need to understand the issue and correct the problem. If it is a common issue, a coder could publish an article to share with the other coders in a newsletter or monthly meeting. The best way to learn something is by teaching it.

Share coding audit data and issues with the entire coding team, who, as mentioned above, can look at it from multiple perspectives and collaboratively brainstorm for a solution.

In conclusion, developing this creative resource where coders directly contribute continuous improvements is a process – it will take time. Coding leadership needs to develop trust, provide open communication, empower coders, define roles and responsibilities, clarify goals, and administer rewards and accountability to implement coder-driven improvements to the organization’s revenue cycle.

Sources:

1. Health Catalyst, 2019.
2. Apepm, 2020.
3. Nuclino, 2021.