The American Health Information Management Association (AHIMA) states that medical coding professionals review and assign International Classification of Diseases (ICD-10) and Current Procedural Terminology (CPT) codes to medical records based on provider and clinician documentation of procedures and patient condition. In addition, Medicare Severity Diagnosis Related Groups (MS-DRGs) and Healthcare Common Procedure Coding System (HCPCS) are used to assist with the processing of claims by giving more specific treatment information in patient documentation.
Accurate and timely medical coding is vital to proper reimbursement from payors, as well as for quality and reporting. Whether you need inpatient, outpatient or professional fee coding, JTS Health Partners’ team of experienced provides solutions to supplement your organization’s coding staff for working claim backlogs or to keep current with new claims.
Accurate and timely medical coding is vital to proper reimbursement from payors, as well as for quality and reporting. Whether you need inpatient, outpatient or professional fee coding, JTS Health Partners’ team of experienced provides solutions to supplement your organization’s coding staff for working claim backlogs or to keep current with new claims.
Medical Coding for Clean Claims
Are your claims clean after passing through the internal claim scrubber the first time?
Each time a claim is re-worked, it costs your organization money. JTS coders have deep expertise to work your claim edits, looking for incorrect codes and/or modifiers that may be the cause of claims being rejected by the scrubber. JTS will collaborate with your team to find the root cause of the identified issues and develop standardized work instructions to ensure proper processes and increase your clean claim rate, thus improving the financial resolution.
Transitioning to a new EHR or a new billing system impacts getting clean claims submitted in a timely fashion. Keeping coding current on a new platform and processing an increased number of coding conflict edits is challenging. By temporarily transferring the coding conflict edits to JTS, your coders will be able to focus on mastering coding within the new EHR/billing system.
Through this team approach, you will reduce the likelihood of new problems, such as spikes in discharged not final billed (DNFB) and increased denials.
Clinical Documentation Improvement (CDI)
As value-based care models gain traction, so have CDI programs in the inpatient and outpatient arenas. A CDI program can be used to incrementally improve physician documentation over time.
Charge Capture
- Does your staff know which charges are hard coded to the charge master?
- Do you have dedicated staff to perform charge capture? Who fills in when they are absent?
- Are departments entering charges in a timely manner? Is their charging complete? Do you know how late charges impact a claim?
The charge capture process differs with every healthcare organization. At its core, an effective charge capture process ensures that the correct charges are posted in a timely manner. However, an ineffective charge capture process will cost your organization valuable time and money. Is your charge capture process enhanced for optimal revenue capture? JTS’ team of experienced coders with CDI expertise offers services to supplement and enhance your CDI program.
Is your Denial Rate less than 10%?
The average claim denial rate is between 5 and 10 percent.
According to an American Academy of Family Physicians (AAFP) report, the average claim denial rate across the healthcare industry is between 5 and 10 percent. Having an automated process to review coding can lower denial rates and improve cash flow. JTS’ nCREAS™ Analytics as a Service solution can identify problematic areas. Learn more about Denial Management in Medical Billing.