Importance of Accurate Medical Coding in Healthcare

Medical coding is the process under which hospitals translate crucial medical information related to each patient into simple codes for documenting medical records and for ease in medical billing and insurance reimbursement. Accurate medical coding lets the insurance service provider know the illness or injury a patient is suffering from and the method of treatment used to treat it and make the appropriate payment. Specialized providers of healthcare BPO services have the requisite capability to ensure accurate medical coding records are available for use by both hospitals and insurance providers.

Why Accuracy in Medical Coding Matters

The data collected about a patient, upon which medical codes are decided, are gleaned from lab results, electronic records, medical notes, transcriptions, urinalysis, radiological assessment, and pathology assessments from hospitals, care centers, and pathology labs that are then forwarded to medical coding firms. This data gives the exact condition of a patient, and accordingly, accurate medical codes are added, which allows for the efficient transmission of data to insurance companies and other healthcare payers, as well as healthcare administrators.

How Medical Coding Impacts Healthcare

Medical coding is done more efficiently by specialized providers of healthcare BPO services. They have the requisite expertise, talent pool, and resources to provide medical coding services as part of their core set of activities. However, if hospitals, whose core activity is patient care, try to involve themselves in medical coding services, they will have to spend time, money, and resources on a non-core activity that will not only eat into their earnings but also create problems about the allocation of resources.

Providing medical coding services requires a proper understanding of medical terms and basic knowledge of human anatomy, without which medical coders could submit invoices to insurance companies with wrong medical codes listing the wrong medical condition. The resulting under- or over-payments could financially impact everyone involved and cause legal issues.

Accurate Medical Coding Ensures Accurate Reimbursement

The importance of medical coding can be gauged from the fact that insurance companies, clearinghouses, and other healthcare payers depend on medical coders to accurately describe what medical services, procedures, and medical devices were provided to a patient to identify an ailment. Besides the insertion of wrong medical codes, insurance claims may be denied or rejected on the grounds of incorrect personal (name, DOB, insurance ID, etc.) or provider information (address, name, etc.), leaving out codes altogether, or entering fraudulent codes.

Specialized providers of healthcare BPO services are fully equipped with experts and quality protocols in place to ensure there is no medical coding oversight and no errors in code input, as such errors can negatively impact the bottom line of medical service providers, the hospitals.

Accurate Medical Coding Improves Patient Safety

Medical coders play a critical role in improving patient safety. The use of accurate medical codes helps assess the health of a patient, identify issues with the quality of healthcare, and even influence public policy. For example, CPT Category II codes are periodically reviewed to evaluate the performance of physicians and other healthcare professionals, as well as hospitals and other facilities, and assess the quality of care provided to patients. By assigning accurate medical codes, medical coders help identify conditions that aid in preventing complications in the future.

Accurate coding also helps healthcare organizations assess the correct cost associated with the condition that a patient is in. Hospital-Acquired Conditions (HACs) are one area in which accurate medical codes make a huge difference. By choosing the right medical code that identifies a condition as a HAC, it can be determined that a condition was not pre-existing but developed as a result of a visit to a medical care facility.

Accurate Medical Coding Allows Uniform Documentation

1. Inaccurate coding affects healthcare, insurance, payments, and many other areas. On the other hand, accurate coding facilitates many features for a patient seeking medical treatment like faster treatment and better facilities.
2. Specialized providers of healthcare BPO services must follow accurate coding guidelines, rules, and regulations and be accountable and open to feedback to continuously improve their skill sets to support medical necessities for medical insurance payment calculation and pre-certification of services.
3. Accurate coding is the most important point for medical billing. Accurate coding and documentation not only ensure accurate, on-time payment but also prevents reimbursement denials or delays.
4. For accuracy in medical coding, healthcare BPO services providers need to adhere to the following:

• Obtaining and verifying the correctness of medical information received about patients from doctors, physicians, and other healthcare professionals.
• Checking if any information is missing that could result in medical insurance claim denial.
• Selecting and assigning medical codes correctly.
• Ensuring that the medical bills comply with medical coding guidelines.
• Informing the medical staff on any specific medical coding requirements.

Final Word

Accurate medical coding allows medical insurance service providers to know the exact illness a patient is suffering from as well as figure out the precise method of treatment used to treat the ailment and make payment accordingly. The importance of accurate medical coding in healthcare can be gauged from the fact that it ensures there is no medical coding oversight that can adversely impact the revenues of medical service providers, such as hospitals, care centers, and others.