Part 1 – Medical Coding Counts: Eight Questions to Ask Medical Billing Companies

As one of the most critical components of the medical billing process, medical coding cannot be overlooked when it comes to ensuring that healthcare providers collect all money due for services delivered. In this blog post, we suggest Key Questions about medical coding. A medical billing company must have stellar coding capabilities to achieve successful financial outcomes for its clients. Unfortunately, many providers fail to investigate medical coding capabilities prior to partnering with a medical billing company. Here are eight key medical coding questions to ask of your billing department, current medical billing company or billing company you are considering. What you don’t ask about coding can hurt your bottom line!

1. Are your coders certified and do they have the specific certifications associated with my specialty(ies)?  It’s impossible to offer superior coding capabilities without employing the best people for the job. Coders should not only have the necessary credentials, but the credentials specific to your area(s) of practice, as well as extensive and relevant expertise, and depth of knowledge required to handle the complexities of the coding process. As an example, AdvantEdge coders have deep credentials in each of our clients’ specialties, including radiology, interventional radiology, emergency medicine, pathology, pain management, and anesthesia, among others, along with certifications and experience in subspecialties (neurological radiology, derma pathology, etc). To help clients keep up with the most current industry updates and changes, ongoing in-house training is required of all coders, including annual ICD-10 and CPT updates. 

2. How quickly can you adapt to planned or sudden and unpredictable changes on the medical coding frontier? Recent history has taught us that change is inevitable and unpredictable. This was witnessed with COVID. A medical billing company must adapt to change efficiently and expediently – whether the change is planned or takes the industry by surprise. AdvantEdge was able to adapt to COVID largely because of the company’s technology foundation and the expertise of its people who were well equipped to work remotely. Due to proprietary technology and extensive protocols that were already in place, the AdvantEdge coding team responded to the new COVID landscape with relative ease. The rapid emergence of telehealth and COVID coding rules were quickly adapted with new training and updated workflows. What’s more, AdvantEdge is also prepared with transition strategies when COVID coding provisions potentially revert to pre-COVID status. As another example, when providers were given the direction earlier this year to select E/M codes based on total time spent or medical decision making (MDM), AdvantEdge was well prepared and quickly incorporated this change.

3. What is your process when dealing with coding related denials? Although denied claims are an inevitable reality, the issue is how – and if – these denials could have been avoided and are dealt with in a way that allows for the best possible financial outcomes. Coding denials should be tracked and trended to identify systemic areas of concern, either related to provider documentation, information flow from provider location(s), or issues related to coding performance within your coding department (or that of the billing company you use).  Quantification and trending of these denials are the best ways to ensure you are identifying and addressing root causes to ensure problems are being resolved and do not perpetuate.  AdvantEdge has a cohesive and time-tested process for handling denied claims to ensure they are addressed and handled expediently. When it comes to claim denials, fast and thorough follow-through is essential to making sure each valid claim is reimbursed for our clients.  Additionally, AdvantEdge provides its clients with detailed denial reports that demonstrate how denials trend over time, to ensure positive progress and momentum, leading to improved and expedited cash realization for clients.

4. How often do you audit your practice’s (or in the case of a billing company, how often do they audit their client’s) documentation for compliance purposes?  A practice doing its own billing, or its medical billing company, must ensure that they, as well as the physicians they serve, are aware of the relationship between documentation and coding in order to remain compliant. This necessitates ongoing oversight and audit of documentation. For this reason, AdvantEdge provides most clients with a formal audit at least annually, offering valuable feedback to help providers understand any issues that may arise and need to be addressed.  As necessary and /or as desired by clients, AdvantEdge also provides them with education on proper coding and documentation. If AdvantEdge notices trends of coding errors or other inconsistencies, root cause analysis is completed followed by an action plan that incorporates preventative measures for moving forward, independent of the audits mentioned above.

5. What is your typical coding turnaround time (TAT)? We all know that time is money. At AdvantEdge, the majority of our clients have a 48-hour coding turnaround time. If there is a unique situation around specific claims, our team is always equipped with an action plan to handle those exceptions. When it comes to medical billing and coding, we understand that time is of the utmost importance.

6. What actions are taken if a payment comes in lower than the current fee schedule allows due to coding discrepancies? Your billers or medical billing company must be aware of the most current contracts and fee schedules to ensure that you get the proper amount due for delivery of services. Your billing department or billing company needs to have a system in place to track payments against contractual amounts, otherwise these underpayments will not be flagged and may get inappropriately transferred to patients or written off as bad debt.  While these “underpayments” may seem arbitrary, oftentimes they are coding related, and you need to ensure you have appropriate documentation to evidence the procedures performed, along with related acuity levels, to overturn such underpayments.  AdvantEdge understands that many providers don’t have time to investigate annual contract and fee-schedule updates, so we keep abreast of these changes and have the systems necessary to load clients’ payer contracts into our system.  This process enables us to identify underpayments as exceptions and follow up with payers to appeal and overturn such underpayments before seeking to collect from the patient or another third party…all to ensure we are collecting all money due to our clients.

7. In the case of a billing company, do clients have access via phone to live coding specialists to answer questions about complex medical coding issues that may arise?  Although technology is integral to the medical coding process, some situations require human intervention. A medical billing company must have coding experts on hand to deal with unique and complex situations that require human intervention and interaction. AdvantEdge realizes the importance of giving our valued clients access to appropriate specialists who can promptly explain, address, and resolve questions that require immediate clarification.

8. Does the company utilize leading edge technology and automated workflows to assure full reimbursement? One of the keys to properly billing for your practice or becoming a leader in medical billing is a company’s ability to incorporate and utilize the latest technologies. AdvantEdge’s proprietary software allows us to quickly adapt to changes in coding regulations, along with all aspects of revenue cycle management [from beginning to end].  This enables us to deploy more human resources where they can have the biggest impact, such as managing exceptions, educating our clients, communicating with your patients, and handling complex claims and other items that may arise in the billing process.

The second blog in our three-part medical coding series will highlight the importance of technology and automated workflows. Until then, keep up to date on AdvantEdge and its medical billing initiatives by visiting our LinkedIn page.