What is the Link Between Medical Coding and Managing Revenue?

by  Find-A-Code™
Nov 20th, 2023

Healthcare administrators and financial officers are very familiar with the management revenue cycle (RMC). They may not be as familiar with medical coding, at least from the standpoints of terminology and best practices. Yet there is an undeniable link between medical coding and managing revenue. What is that link? It is data.

Revenue management in a healthcare setting is a multi-faceted enterprise. So many things play into the revenue cycle that it can be hard to keep track of all of them. Therefore, different departments need to be diligent about the data they contribute to the RMC equation.

Bad Data Throws Off Revenue

From the medical coder's standpoint, patient and treatment data is their contribution to the revenue cycle. The more accurate the data, the better the contribution. Inaccurate data only leads to challenges that often interrupt the cycle.

For example, inaccurate patient data can lead to inaccurate claims. The obvious solution to such problems is implementing office practices designed to ensure that all patient information is continually checked and updated. Whenever a patient visits, information should be verified. Information should be checked and double checked against existing records before filing claims.

Coding and Billing Data

In terms of actual bills, medical codes are critical. It is the medical coder's responsibility to ensure proper coding of every procedure, service, diagnosis, etc. But coders are only as accurate as the documentation that informs them. Outdated ICD-10 codes lead to inaccurate bills. Likewise for ICD-11 codes, CPT codes, and so on.

It is imperative that coding specialists are experts in all the major code sets. Medical billers should be equally adept so that they can spot potential errors made by coders. Medical coders and billers obviously cannot memorize every single code they work with, but they can become familiar enough with said codes to both minimize errors and distinguish between codes when multiple options are available.

3 Keys to Ensuring Better Data

Managing the revenue cycle is part and parcel with operating a successful medical practice. Whether it is a hospital, group practice, or small-town clinic, revenue is key to an organization's survival. If the revenue cycle is not properly managed, things fall apart. Therefore, the data that feeds revenue management needs to be accurate.

There are three keys to ensuring better data:

1. Technology and Infrastructure – Leveraging the latest technologies in data processing should be a given for every healthcare facility. They include technologies capable of improving medical coding and billing accuracy. In addition, deep learning and AI-heavy technologies need robust infrastructure to support them.
2. Customization – One of the best ways to improve data accuracy is to employ customization in everything from software choices to office policies. No two healthcare facilities are identical. No two office environments work the same way. Organizations need customized solutions to account for all the factors that go into how they do business.
3. Knowledge and Experience – There is no replacement for a solid body of knowledge and years of experience. Improving data accuracy relies heavily on both. The more knowledgeable and experienced team members are, the more capable they are of generating accurate data.

The link between revenue management and medical coding is data. Coders and billers supply the data that keeps revenue flowing in. If that data is inaccurate, revenue streams are slowed down. Sometimes they are even interrupted.

If better data management is not part of your organization's RCM strategy, it is time to change things. Better data produces better results. The better your organization's data is, the easier and more successful RCM will be across the board.