The Claimocity Blog
Hospitalist Coding with Integrity to Reduce Under Coding
Under-coding results in lost revenue.
Over-coding creates unnecessary long term risks for audits and harsh penalties.
how do you code with accuracy and integrity to maximize revenue and minimize risk?
The answer requires understanding the problem in the first place. Insurance companies have a clear financial incentive to make the coding and claim system as complex and problematic as possible because every under-coded visit, denied claim, unresolved issue, or mistake in the process allows them to pay less than they should. They have protections in place against long-term patterns of over-coding and these deterrents have the added benefit of pushing many doctors to play it over-safe and under-code just to make sure they are not putting themselves at risk.
In 2019, an independent third party survey of physicians found that nearly 40% ranked coding
errors as one of the most important issues and 83% felt that improving their coding tools was
one of their top four focuses for the coming year and a critical component to financial growth.
Issues with our level coding never seemed like an issue until we switched software and experienced what it was like to have the tools in place to do a better job. We thought our financials would go down because it was common knowledge that several doctors in the practice consistently over-coded visits but the reality was that so many of the physicians were unintentionally coding below optimal levels, or since we often cover for each other, mistakenly coding initials as follow ups, that we actually increased net revenue by 8%.
Solutions for Accurate Hospital Coding
But while there is a clear understanding of the need for better coding and a clear sense of the problem, what are the solutions?
Here at Claimocity, we know that Hospitalists depend on coding accuracy not only for financial viability but from a practical standpoint of progression from initial visit to a series of follow-ups to eventual discharge. Mistakes int he process make it difficult to ensure that a patient is getting the optimal care pattern, especially when doctors are covering for each other and you have to pick up where another Hospitalist left off using nothing but the medical records on file.
Three years before the 2019 study emphasizing the point about the need for better coding, we were developing the very tools that everyone now recognizes as vital to short and long term success. Our software is a world-class blend of smart technology and billing expertise, and our founders and support staff are global billing experts with decades of experience in the medical industry who specialize in hospital coding.
Our billing experience and expertise makes us uniquely
qualified to analyze level coding for accuracy and integrity.
And when you combine this hands-on professional insight with the most robust data processing, machine learning algorithms, historical pattern analysis, and advanced statistical modeling in the industry, you get coding tools that take all the guesswork out of the process.
We’ve taken the mystery out of the process, and not only help Hospitalists code with accuracy and integrity in a way that maximizes coding revenue and minimizes risk.
Claimocity uses a proprietary smart software level coding optimizer that analyzes the codes entered
at the point of care, performs an initial error analysis within any available pattern data for context before
evaluating the integrity and accuracy of the level coding against huge volumes of historical data.
Not only does it catch the clear outliers on either end of the spectrum and immediately offer notification insights and alternatives, but it generates an ideal set of matches within the parameters of the visit and offers subtle improvement suggestions that offer revenue capitalization without compromising the integrity of the diagnosis or moving outside of the lowest levels of risk.
Ahead of the curve in so many ways, this tool sets the bar for what is possible and addresses the concerns over coding errors and allows you to ensure that your diagnosis codes are submitted properly with accuracy and confidence.
Our customers love this feature and have reported over a 90% increase in feelings of comfort and understanding in the coding process since they started using our software.
