Tackling Reimbursement Challenges posed by Inpatient Coding with Professional Medical Billing and Coding!

The fact that inpatient medical coding deals with patients after they are discharged from health centers makes it widely different and much more complicated than outpatient billing and coding. Inpatient billing and coding has to account for the entire set of eventualities stemming from a patient’s stay in a medical facility, almost requiring a coder to combine the qualifications and knowledge of a medical practitioner as well as a coder. For example, the coder reviews records of discharged inpatients, assigns standard procedural codes, sifts through documentation in medical records to summarize statistical data, determines different levels of diagnoses.

The records and analysis billers and coders review to prepare claims capture the details of multiple medical situations a patient goes through during his/her stay in a hospital. These medical situations are not just numerous (or at least quite a few) but often are overlapping in nature. Generally, both in inpatient and outpatient billing, each medical situation can involve a different medical service warranting a separate CPT and HCPCS modifier.

However, in inpatient coding and billing, generally involving a long hospital stay, medical situations often become overlapping in nature, making it a challenge to spot where a medical situation ended and another began, leading to assignment of inaccurate modifiers, which results in rejection of claims. Additionally, inpatient treatment episodes are mostly covered by Medicare Prospective Payment Systems (PPS) which bunches hospital services together into groups and involves a different set of codes applicable to these groups. This grouping scenario, in general, is further compounded by bundled payments which combine various services in a treatment episode starting from pre-hospitalization diagnosis to post hospitalization care to present a composite fee.

This is why healthcare setups are increasingly outsourcing their inpatient billing and coding processes to professional billers and coders. But, surprisingly, even this has not stopped inpatient billing from being a source of concern for medical outfits and professional coders alike. It is quite simple to understand: preparing inpatient claims brings together challenges that are specific to inpatient claim preparation as well as problems that are common to other areas of billing and coding. To meet the challenges adequately, a billing and coding outfit requires an experienced team of billers and coders, who can combine medical and coding knowledge to go through medical records, understand diagnoses and identify appropriate codes for them. It requires a robust data management system to maintain and seamlessly refer to medical records pertaining to inpatient treatment episodes. It also requires appropriate software platforms to transact data without compromising on its privacy, failing to do which can cause non-adherence to HIPPA.

With intricate procedure coding, accurate charge capture, electronic filling, Medicalbillersandcoders.com the largest Medical Billing and Coding consortium in the US has helped both small and big healthcare centers to bring down their claim rejections and improve revenues.

If you are a large medical outfit with an in-house team of billers and coders to handle claims, as part of our Revenue Management Consulting services, we can prune up your revenue management system by advisory services to help in - replacing bumbling software applications with new ones suiting your purpose and environment, sprucing up your lengthy processes or replacing them with new ones if required and training people in inpatient billing and coding techniques and methodologies.

However, for practice’s which don’t need an in-house team of billers and coders or any reason to have one, can also outsource their entire billing and coding process to MBC to help nullify their claim rejection rates and boost revenues.