Many American hospitals are in a bind. Amid the continuing pandemic, staff shortages, and changes in laws and regulations, many no longer have concurrent CDI nurses looking at charts, have less oversight by chief medical officers who are instead focusing on COVID-19 patients, and don’t have internal coders. Some are filling the void by contracting services with coding agencies. This may fulfill a need in the short-term but can cause other issues down the road. Here are three problems that can arise from relying only on contracted coders for coding services.
Problem 1: Errors
Coding standards changed several times in 2020 in response to COVID-19. A new set of guidelines started Jan. 1, which includes 21 new ICD-10 procedure codes for COVID-19 vaccines and therapeutics. Non-clinical coders are finding it difficult to keep up with, understand and comply with all of the new guidelines. And as they code what they see in charts, they probably don’t catch omissions, upcoding and under coding mistakes in the EMR, as well as copy and paste errors.
Problem 2: Denials
Payers demand increased specificity in the coding and medical necessity, and denials have become more frequent. Anything that is not specific enough or not clinically valid is denied. Coding agencies present their work to hospitals with no guarantee that the coding is as accurate and clean as possible for billing.
Problem 3: Continued Patterns of Mistakes
When coders are pressured to complete charts with little to no awareness of their errors, mistakes will perpetuate. This cycle leads to continued denials from payers and possible flags during CMS and OIG audits.
How We Can Help
The Paramount Health Solutions physician-led team starts by conducting a 90-day pre-bill audit. During the pre-bill review, we provide ongoing reviews to make sure opportunities are not missed and we also provide education to the physicians on the trends we’re seeing and why their bills are being denied. We teach in-house physicians how to compare and contrast the coding language with the clinical language. That’s when the lightbulb goes off – they see the reason why they need to change their documentation. They learn about differences between what they are taught in medical school vs. what actually has to be written in the coding language for accurate documentation, coding and billing. Paramount Health Solutions provides a second level of review beyond coding staff to catch errors, ensure compliance, and make sure there aren’t lost opportunities. We also guarantee that the most appropriate bill will be sent for the charts we have reviewed, and we’ll write an appeal if any of our recommendations are denied by a payer. In these challenging times, it makes sense to work with physician CDI/DRGV experts who have deep knowledge of both the clinical and coding areas and a proven track record of ROI for the clients we serve.