AS HEALTHCARE SERVICES migrate toward outpatient settings, hospitals and health systems are struggling to ensure
coding accuracy and quality for owned practices and clinics.
With the steady increase in outpatient services, revenue integrity challenges are more complex than ever. And the expansion
of those services is further complicated by the rising volume of
mergers and acquisitions.
Earlier this year, Definitive Healthcare released its 2019
Healthcare Trends Survey, which tracked 803 mergers and acquisitions as well as 858 affiliation and partnership announcements. The healthcare analytics firm predicted the consolidation trend would accelerate in 2019 and beyond. As mergers
increase, health systems must integrate coding from physician
practices, emergency departments, radiology, pathology, anesthesia, and more, meaning revenue integrity on the outpatient
side is now susceptible to chargemaster errors, missing codes,
and documentation gaps, which are increasingly difficult to
identify, track, manage, and improve.
Today’s Outpatient Revenue Integrity Challenges
Managing the claims editing process: The claims editing process on the outpatient side has become a part of
the coding process to address edits such as missing documentation, multiple codes, and charges on the account. To
resolve issues, coders need access to the Centers for Medicare and Medicaid Services (CMS) website at https://www.
cms.gov, where they’ll find resources and tools—including
claims-scrubbing software, analytics programs, and other
applications—to help them pull together the necessary
pieces of information to ensure that claims are properly
submitted. The claims editing process has become increasingly difficult as organizations struggle to maintain
skilled, knowledgeable staff at levels sufficient enough to
complete the continuing increase of complex work.
Merging professional fee and hospital outpatient coding: When physician practices are integrated with healthcare systems, professional fee services coding and billing
Six Strategies to
By Keith Olenik, MA, RHIA, CHP