Academic medical centers (AMCs), which offer a unique combination of disease management, scientific research, academia, and hospital administration, are organizations that not only deliver medical care but also further the horizons of healthcare. Despite their substantial contributions, AMCs encounter several difficulties with medical coding. We examine these difficulties and offer potential solutions in this in-depth analysis.
Case Complexity
AMCs are known for providing complicated medical care, which frequently entails rare and intricate procedures. Medical coders must therefore be very knowledgeable in various coding systems, including CPT, HCPCS, and ICD-10. Furthermore, AMCs frequently conduct experimental methods as part of their research projects, which can be difficult for coders due to the lack of established coding guidelines or prior experience with these novel techniques.
High Volume of Coding
Academic medical centers typically have many patients, and each patient encounter necessitates coding. High Volume of Coding: Academic medical centers usually have many patients, and each patient encounter necessitates coding. This high coding volume can overwhelm coding staff, increasing the likelihood of errors if not appropriately managed. Medical coding managers must devise strategies to handle the workload, maintaining accuracy and efficiency.
Regulatory Compliance
Compliance with Regulatory norms: AMCs must adhere to various regulatory standards, such as HIPAA, CMS, and state-specific laws. Failure to comply with these regulations can result in fines and legal consequences. The Office of Inspector General (OIG) has found that AMCs are at a higher risk for noncompliance with Medicare billing rules than other healthcare providers, necessitating increased vigilance in maintaining compliance.
Physician Documentation
Accurate coding relies heavily on the quality of physician documentation. However, AMCs frequently require assistance with inconsistent or missing documentation. The complexity and volume of documentation increase due to the engagement of a multidisciplinary team in patient care, making it more challenging for coders to get the information required for precise coding.
Staffing and Training
Attracting and retaining qualified coding staff can be challenging for AMCs due to the high demand for skilled coders and the demanding nature of the work in Academic Medical Centers. Staff turnover rates can be increased, and coders require ongoing training and education to stay up to date with the latest coding requirements and regulations. Compounding this issue is that AMCs need to pay the same compensation levels as private institutions.
Strategies for Tackling Coding Challenges in AMCs:
Academic Medical Centers (AMCs) face unique coding challenges, making it crucial to implement effective strategies that ensure accurate coding, regulatory compliance, and support for their core mission. Here are six strategies that medical coding managers can adopt to optimize coding processes in AMCs:
Develop specialized teams
Medical coding managers should assemble specialist teams of coders with expertise in complex cases and experimental procedures to meet the specific coding requirements of AMCs. These teams can ensure accurate coding and reduce errors, providing quality care to patients.
Focus on staff retention
Providing a supportive work environment, competitive compensation, and opportunities for professional growth can help retain skilled coding staff, ensuring consistency and accuracy in coding practices.
Provide ongoing training
Investing in coder education is crucial to maintaining coding accuracy, ensuring regulatory compliance, and improving overall patient care in AMCs. Regular exercise through conferences, webinars, and other educational opportunities provides coders with the knowledge and skills needed to handle complex coding scenarios, stay current with coding requirements, and identify opportunities for improvement. Continuous education can help coders remain engaged and motivated, improving staff retention and overall coding quality. By prioritizing coder education, AMCs can optimize their coding processes and improve patient outcomes.
Improve physician Collaboration
Collaborating with physicians to enhance documentation practices and capture all necessary information in patient records can significantly reduce coding errors and improve overall patient care. Medical coding managers can facilitate this collaboration by offering physician training sessions, providing feedback on documentation practices, and establishing clear documentation guidelines. By working together to improve documentation practices, physicians and coders can ensure that all relevant information is accurately captured in patient records, improving coding accuracy and reducing billing errors.
Use technology and automation solutions
Implementing technology solutions such as computer-assisted coding (CAC) and natural language processing (NLP) can significantly improve coding efficiency and accuracy in AMCs. These tools can identify and extract relevant information from clinical documentation, reducing the time required to complete coding tasks and minimizing coding errors. CAC can also help coders to navigate complex coding scenarios by suggesting appropriate codes based on clinical documentation, enabling them to code more efficiently and accurately. Natural language processing (NLP) can help coders to identify important information in unstructured clinical notes, improving coding accuracy and completeness.
Partner with outsourcing providers
Outsourcing coding can provide AMCs access to specialized expertise and technology that may not be available in-house. Medical coding managers should consider partnering with outsourcing providers to help manage their coding needs during peak periods or to address specific coding challenges. By implementing these strategies, AMCs can optimize their coding processes, ensure regulatory compliance, and provide quality care to patients.
Medical coding managers in academic medical centers can effectively address the unique challenges associated with medical coding in AMCs by implementing a combination of strategies. By developing specialized teams, focusing on staff retention, providing ongoing training, improving physician documentation, leveraging technology solutions, and partnering with outsourcing providers, medical coding managers can help ensure accurate coding and compliance with regulatory requirements.
These efforts will contribute to academic medical centers' financial health and support their mission of providing high-quality patient care, advancing medical research, and training the next generation of healthcare professionals. By proactively addressing coding challenges, AMCs can continue to excel as important institutions in the healthcare landscape.
By:
Sree LEkshmi, CDIP,CCS, AHIMA-Approved Revenue Cycle Trainer
Sree Lekshmi is an experienced healthcare professional specializing in medical coding and documentation improvement. As the Assistant Vice President and Head of Inpatient Coding & CDI at Pacific Global Inc, she brings over seven years of expertise in the field. Sree holds certifications such as Certified Documentation Improvement Practitioner (CDIP®), Certified Coding Specialist (CCS®), and Certified ICD-10 Consultant®. Her top skills include medical coding, medical terminology, and ICD-9. With a strong background in revenue cycle management and ethical leadership, Sree has been recognized as a speaker at the 89th Annual AHIMA Convention. Connect with her on LinkedIn: www.linkedin.com/in/sree-lekshmi-a9944a43.