Medicare Claims Coding:

Best Practices for Hospitals to Maximize Medicare Reimbursement

Keeping up with changes to Medicare coding and claims processing is challenging for hospitals, but it is also extremely important. Inaccurate or suboptimal coding of diagnoses and treatments results in missed reimbursement opportunities—which hospitals only have a short time to correct and claim. And, unfortunately, the job ensuring accurate coding of Medicare claims just became five times more complicated due to the shift to ICD-10.

Healthcare Payment Specialists Chief Product Officer John Garcia discusses best
practices for hospitals to ensure accurate coding of Medicare claims
and avoid missed reimbursement opportunities.

The Transition to ICD-10 Amplifies Pressure on Hospital Coding Departments

The purpose of moving from ICD-9 to ICD-10 is largely to increase reporting granularity from a procedure and diagnosis perspective. This allows hospitals and CMS to do more extensive reporting with the end goal of providing better care for patients.

Making the jump to ICD-10 ultimately makes it easier for hospitals to adapt to new technologies and procedures, while keeping data organized and accurate. However, there are significant challenges that come with the transition. The number of codes increased from approximately 14,000 to 69,000—which means hospital coding departments are dealing with almost five times as many data points.

This is especially challenging because coding remains such a labor-intensive manual process at many facilities. Hospitals are dependent on highly skilled, experienced coders to make sure every digit is correct and every available dollar is claimed.

It’s become more and more important for hospitals to get Medicare claims right the first time, because auditors have become increasingly strict about reopening cost reports to claim missed reimbursements. Reviews and corrections usually need to happen within sixty days or the revenue is permanently lost.

3 Strategies for Hospitals to Manage the Post-ICD-10 Revenue Cycle

Because of the additional complexity associated with ICD-10 and the manual nature of coding, it is crucial for hospitals to have procedures in place for comprehensive coding reviews, so they can continually improve their practices and prevent lost reimbursements.

1. Implement Technology to Optimize Medicare Reimbursement

Knowing where and how to implement technologies and tools to analyze healthcare data is crucial for conducting accurate reviews of coding. Better technologies allow for deeper and more dynamic auditing of data and more thorough reviewing, which helps hospitals receive full reimbursements. Given the tight deadlines and large volumes of data involved in these reviews, hospitals should consider visibility and speed as top priorities when implementing new technologies to manage Medicare reimbursement.

2. Evaluate Coding Consistently to Identify Missed Revenue

Since ICD-10 coding is significantly more complex than ICD-9, consistency in reviewing coding is critical. Frequently taking a retrospective look at coding assignments helps identify any potential deficiencies or inaccuracies with coding within the allowed time period to re-bill. Without at least monthly audits, hospitals run the risk of identifying problems only after it’s too late to claim the missed reimbursement.

3. Stay Ahead of Tight Medicare Auditing Deadlines

If you do identify a problem with coding shortly after it is billed, the pressure is on to deal with it as quickly as possible. Medicare requires that hospitals submit corrections to claims within a specified amount of time; most hospitals have roughly sixty days from when original bill was dropped to go back and make changes to the claim.

Learn More about How to Maximize Medicare Reimbursement

Hospitals need to approach these challenges from a data perspective. There is a huge volume of information that must be reviewed to identify and correct under-reimbursed claims, which is why technology and consistent processes are so important.

Healthcare Payment Specialists provides hospital revenue cycle analytics that enable hospitals identify their top reimbursement issues, find missed revenue quickly, and avoid future underpayments by getting claims right the first time they’re filed.

Contact us to learn more about our specialized STINGRAY™ platform or check out our blog for more healthcare payment news, analysis, and updates.

Healthcare Payment Specialists

Healthcare Payment Specialists

Founded in 2002, Healthcare Payment Specialists (HPS) provides technology enabled solutions for health care eligibility, government reimbursement and compliance to hospitals and healthcare systems across the country. Using its STINGRAY software platform, HPS delivers solutions on a software-as-a-service (SaaS) basis or through outsourced service engagements.
Healthcare Payment Specialists