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Why Medical Coding is So Important for Revenue Cycle Management in Medical Billing

Oct 19, 2022 10:00:00 AM / by Altruis


 Altruis explains why revenue cycle management in medical billing relies so strongly on diligent coding and charge capture activities.

A healthcare practice’s financial stability often hinges on proper coding and charge capture. If your medical coding is out of control, your medical practice is out of control. This is where proper revenue cycle management in medical billing comes in. And, in this post we’ll explain how to improve your revenue cycle management with the right medical coding services.

Coding is a key aspect of revenue cycle management in medical billing, which strongly impacts your practice’s ability to serve its patients and stay afloat. Getting a firm grip on your coding and charge capture activities could be the best thing you ever do for your practice.

What Is Revenue Cycle Management in Medical Billing?

The revenue cycle is a critical component of healthcare, and it is a dynamic field that is constantly evolving. The development of new technologies and value-based care have resulted in significant changes in the industry. As such, healthcare professionals must understand their revenue cycle status in order to provide the best care for their patients and receive reimbursement for their services.

Essentially, revenue cycle management involves all phases of the patient's experience with a healthcare organization, from registering with the office to submitting claims to insurance companies and collecting payments. Some aspects of revenue cycle management are administrative, while others are clinical. It involves collecting patient demographic and insurance information prior to each visit to ensure that all necessary information is correct and up-to-date. It also involves checking for changes in the patient's health insurance information, and following up on past non-payments.

Medical Coding Is at the Core of Healthcare

Medical coding uses alphanumeric codes to represent every medical service, procedure, diagnosis, and piece of equipment. This creates a universal language for discussing medical topics and arranging payment for medical services rendered.

It’s also part of the U.S. healthcare system’s accountability-based reimbursement for programs like Medicare and Medicaid. Without proper coding, these programs will deny your claims and valuable reimbursements.


Best Practices For Medical Coding and Charge Capture

The medical coding experts at Altruis have developed a set of standards that support strong revenue cycle management in medical billing. Here’s our list of best practices from Chris Caspar, the CEO of Altruis.

Rapid Reviewing

Reviews of coding should happen within 8 to 12 hours. Some systems allow just 72 hours, so it’s a good idea to stay well within this window and make it a goal to review every encounter within 12 hours in case there’s a problem.

Clinical Coding Alignment

Ensure clinical notes are perfectly aligned with the proper medical codes. This should be a built-in part of the review process, where clinicians’ notes are always carefully checked against codes to ensure they match.

Current Codes

Medical codes change constantly and outdated codes cause confusion in the reimbursement process. Ensure your coders aren’t using incorrect codes and stay up-to-date on new codes. For example, during the COVID-19 pandemic, many practices fell behind on coding because they weren’t current with the latest data.

FQHC Compliance

Federally Qualified Health Centers (FQHCs) can miss out on reimbursements due to coding non-compliance. This results in lost value and the potential loss of a vital practice for local patients who need healthcare services. Ensure you maintain FQHC compliance through proper coding.

Address Rejections/Denials Immediately

Reimbursement denials often happen overnight, so your coders are faced with a daily onslaught of fresh issues to handle. Make sure these are addressed urgently and yesterday’s denials aren’t allowed to persist into the following days. 

Establish a predictable, tight cadence of receiving the day’s responses, addressing any rejections or other issues, then moving forward with pursuing successful claims. Otherwise, you’ll have a backlog of work that prevents an efficient revenue cycle.

Common Pain Points With Medical Coding

Medical practices often face challenges in consistently accomplishing proper coding. Here are some of the most common paint points.

  • Ensuring new practitioners follow practice procedures
  • Retraining existing practitioners on new coding rules
  • Finding persistent mismatches between diagnoses and codes
  • Lack of a dedicated or certified medical coder/service
  • Backlogs and other procedural roadblocks to reimbursements
  • Practitioners and medical coders who are overloaded with work
  • Codes changing too fast for your procedures to handle
  • Lack of preparation for audits

As you can see, there’s a long list of things that can go wrong with billing in a medical practice. It’s easy to see why so many practices address these common pain points by contacting a medical business services partner like Altruis. 

Why Partner With Altruis For Revenue Cycle Management in Medical Billing? 

Altruis is different from traditional medical coding services because we take a proactive and collaborative approach. Our team examines your practice, helps monitor your business processes, and provides helpful feedback about optimization to drive toward profitability. 

This means we interact with each client in an individualized and customized way. We’ll look into any issues or challenges you’re experiencing and dig down to the root of problems to find satisfying resolutions. By taking this proactive approach, we speed up the business cycle and allow your practice to run more efficiently. 

Plus, digitized and automated processes eliminate errors and ensure you’re capturing the maximum possible value of the medical services you provide. It’s easier to handle any issue that arises in your practice, including generating the documentation that comes with audits.

Your practice can also take advantage of revenue-building programs like RetroPay.TM This proprietary Altruis program reviews your patient records for aging charges that can be retroactively claimed through Medicare, Medicaid, and other payment sources.

Together, these benefits show why Altruis is much more than just a billing platform or coding process. We’re your full-service partner in revenue management. Through thriving partnerships, we optimize and maximize medical practice potential.


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Topics: Revenue Cycle Management


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