Gearing Up for Inpatient Medical Coding and Reimbursement Challenges

“The prevalence of such demanding challenges is reason enough to push physicians beyond their Medical Billing Management capabilities, which invariably results in compromised medical efficiency. Therefore, physicians – faced with insurmountable challenges of inpatient medical billing management – have either to set up a dedicated team in-house or look elsewhere for competent outsourced solutions.”

Unlike coding and reimbursement for Outpatient Services, Hospital Inpatient coding and reimbursement is altogether a different proposition – the extensive diagnostic, preventive, and curative procedures administered over a considerable time of patient-stay at the hospital demand accurate charge-capture, billing, compliant coding, and timely claim submission. Further, the overlapping nature of medical situations prompts apt application of Modifiers to nullify the probability of claim denials by insurance carriers.

The prevalence of such demanding challenges is reason enough to push physicians beyond their Medical Billing Management capabilities, which invariably results in compromised medical efficiency. Therefore, physicians – faced with insurmountable challenges of inpatient medical billing management – have either to set up a dedicated team in-house or look elsewhere for competent outsourced solutions. While large hospital set-ups can withstand the heavy investment outlay required to set up such dedicated in-house Medical Billing Management, it is the marginal individual practitioners who find the scenario tough manage. For such population of physicians, outsourcing seems to be the only recourse.

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While the market is flooded with innumerable service providers, yet, it is advisable that an apt and competent provider is engaged for the occasion. The following underlying factors should be of invaluable help in choosing ideal one for the occasion:

• Does your service provider possess reimbursement and methodologies specific to inpatient practice settings? One of the primary requisites, the service provider’s adequacy in reimbursement and methodologies specific to inpatient practice settings will go a long way in determining the requisite qualification for taking on the incumbent challenges.
• Is your service provider capable of Structuring and organizing of Medicare inpatient acute care Prospective Payment System? Although specific to Medicare beneficiaries, yet, it is important to gauge your service provider’s ability to devise such ingenious measures as your practice is bound to encounter a majority of Medicare patients.
• Does your service provider understand the relationship between coding and Diagnostic Related Group (DRG)? As the your practice is likely to encounter several incidents that have affinity to DRG based coding for inpatient medical services, it is important to screen your service provider for the capability in relating coding and Related Group (DRG)
• Does your service provider possess the data quality and coding compliance processes related to coding and reimbursement for inpatient services? Data quality, the foundation on which an efficient medical billing management thrives, is of utmost importance. Therefore, it is necessary to establish the presence of EHR system in compliance with HIPAA norms. Further, it is equally important to know how best such a system is utilized for compliant coding and reimbursement processes involved in inpatient set-up.

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Coupled with such a comprehensive screening program prior to selection of an apt service provider, care must also be taken to assess your service provider’s proactive outlook to ICD-10-CM and ICD-10-PCS, and their impact on inpatient reimbursement; affinity to information on Recovery Audit Contractors (RAC) audits, keeping abreast with information on MS-DRGs and Medicare reimbursement in other inpatient settings; and materials on periodic changes in coding, and coding compliance.

Whereas such a screening is indispensable for avoiding being embarrassed with wrongful choice, the task is usually resource and time-consuming – forcing physicians into a quandary. Fortunately, Medicalbillersandcoders.com (www.medicalbillersandcoders.com) – complete with accurate charge-capture, intricate procedure coding, electronic filing of claims, patient billing, multi-tiered appeal process, denial elimination initiatives, and compliance standards – should make their selection process easier, less-time and re-source consuming.

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