The role of Medical Coders in the Revenue Cycle Management

Medical coders play an important role in the revenue cycle management for the healthcare ecosystem, however, they are rarely mentioned.

In layman’s language, medical coders are the prominent professionals who translate unstructured medical lingos into structured medical codes for accurate medical billing.

In this article, we’ll explore how medical coders play an important role in the healthcare ecosystem and what makes them an indispensable part of medical reimbursements.

First, let’s focus on the impact of Medical Coding on the Revenue Cycle Management

Medical coding is an integral part of revenue cycle management preceding a claim submission. Therefore, accuracy in coding will determine the revenues and reduce denials for the insurance companies, also known as, healthcare payers.

AI-Based Medical Coding software solutions help prevent medical coding errors.

A patient diagnosis recorded in the form of medical codes is documented not only to claim reimbursements from the CMS but also to ensure the quality of care to be offered in their future visits.

Types of Medical Codes Used by Medical Coders

According to the World Health Organization (WHO), about seventy per cent of the world’s health expenditures (USD $3.5 billion) are allocated using ICD for reimbursement and resource allocation.

 The current ICD-9-CM system has ∼13,000 codes that are depleting, while the new ICD-10-CM system has ∼68,000 codes and has flexibility for expansion.

 The ICD-9-CM codes consist of three to five characters, which are numeric with the exceptions of the V codes (factors influencing healthcare), E Codes (external causes of injury), and M Codes (neoplasm morphology) that begin with a single letter.

 The new ICD-10-CM codes consist of three to seven characters that are alphanumeric

A quick comparison of the ICD-9-CM system & ICD-10-CM system in an image:

How Medical Coders are playing an important role in improving Revenue Cycle Management for Payers and Providers?

Claim Filing and Submission

Submitting diagnosis codes to the CMS is crucial for the overall process of healthcare reimbursements, which directly depends on the medical coding. Therefore, medical coders need to ensure accurate coding for timely reimbursements from healthcare payers. Any potential errors need to resolve quickly and efficiently.

Claim Denials

In the case of claim denials from the CMS, the medical coding professional steps in to identify and resolves the errors to ensure that the correct or missed diagnosis codes are resubmitted in a timely manner.

Collections

In the case of inappropriate reimbursements or reduced reimbursement from the CMS, healthcare payers or insurance companies follow up with the medical coders to make adjustments as needed or document the errors for future consideration when billing.

The role of medical coders is undeniable which directly impacts the revenue cycle process to ensure that healthcare providers receive proper payment to keep facilities running smoothly and ensure high-quality patient care.

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Ending note

NLP-Powered Medical Coding Solution is the current buzzword that is helping medical coders: