Introduction:

Clinical IT solutions can go a long way in reducing overall costs and increasing efficiency in healthcare. Ranging from hospitals to independent clinics, all healthcare organizations place cost efficiency and service excellence among their priorities. Automation of clinical IT systems can be critical toward achieving these priorities. The crux of automation can be defined as the deployment of IT systems that control functionalities and reduce human involvement in the organization of data and monitoring of services. Automated IT systems have been maximized in other industries for many years now. However, the healthcare industry is now turning to these solutions for increased efficiency. The financial department benefits significantly from healthcare software product development within the healthcare industry.   

Through clinical coding solutions, automation reduces the burden on the administrative staff of redundant jobs and increases focus on intelligent and satisfying arenas of work. The automated processes take manual data entries, and medical staff can focus on intelligent analytics and supervisory processes. Clinical management solutions can be incorporated into custom healthcare software solutions to increase efficiency across the entire lifecycle of caregiving. Specifically, medical coding software solutions simplify the financial processes between patients, providers, and payors. According to a recent study, almost 95% of healthcare providers display a keen interest in adopting medical coding solutions.   

At OSP, medical coding and verification, especially clinical labs, where one of our client’s main concerns, resulting in high claim denial rates and loss of revenue. To address this challenge, OSP’s custom-made claims prediction software solution solved the client’s challenge of coding and verification and boosted the company’s productivity. The system’s highly accurate and efficient prediction of the possibility of claim approval and the estimated settlement date and amount directly translated into a significant increase in revenue.  

Integral Features of Clinical Coding Solutions

Integral Features of Clinical Coding Solutions

1. ICD-10 Integration

Medical coding and billing is a process that is prone to consistent errors due to the constant updates and changes in medical codes. Revenue cycle management is adversely affected through rejected or denied claims, usually resulting from inaccurate coding. Claim denials due to incorrect coding are a common challenge with healthcare organizations. The U.S. medical coding system is constantly changing to add to the dilemma. The previous year witnessed unprecedented coding changes due to COVID-19 and the related advanced telehealth solutions that came as a consequence. Therefore, medical coding and compliance solutions need to be designed toward automated adaptability of ICD-10 and the soon-to-be-introduced ICD-11 codes.   

2. Adaptability

Apart from the nature of consistently evolving codes, the pandemic has placed a heavy strain on healthcare organizations. Advanced technologies, applied toward healthcare management, can reduce this burden considerably. It is no wonder that healthcare organizations are looking to automate tasks related to finances and billing. With flexible medical billing and coding software, data is extracted from medical records to enable further coding and streamlining or avoid errors. Medical billing companies are spared a heavy burden when the software is equipped with efficient and accurate coding methodologies. The healthcare revenue cycle management process is instantly uplifted through fewer errors, which translates to higher profits.   

3. Claims Management

Coding medical software solutions play a vital role in countering the rising medical claims denial rate and adherence to stringent federal regulations. Automated healthcare solutions can offer tailor-made medical claims processing services to seamlessly integrate multiple complex systems, platforms, and manual processes into the medical claim processing workflow throughout the life cycle. Medical coding systems software solutions should be outfitted with intelligent integration capabilities that perfectly synergize with existing administration systems. By incorporating medical claims processing software solutions, there can be a check for coding and billing errors, pre-adjudicate the claim for accuracy, and receive denied claims and re-adjudicate them effectively.  

4. Cloud-based Hosting

Efficient coding systems in healthcare involve financial reports, patient documentation, and claims reporting as core components that can be integrated through healthcare cloud computing. Good medical billing and coding software should be able to access and update these reports in an automated fashion. Robust reporting technologies allow seamless workflow between caregiving and billing, providing an all-rounded efficiency. Ideally, a cloud-based solution that interconnects all patient-related information is an efficient methodology toward consistent data access.   

5. Advanced Security

Medical billing and coding software requires stringent quality and security checks. A medical coding software of the healthcare industry must look into the security requirements relevant to it, specifically with the security of financial information. During the medical coding software development process, keen attention needs to be paid to the applicable international and state laws. Healthcare software deals with sensitive patient health data, and therefore, developers need to ensure that security provisions are in place to ensure no breaches. If opting for integrated healthcare solutions, close attention should be paid toward all-rounded security and quality standards.   

6. Data Efficiency

Whether it’s medical billing and coding, medical billing codes, online doctor appointment scheduling, healthcare data integration, or electronic data exchange, efficient medical coding software should prioritize data efficiency. Another trigger for medical billing errors is inaccurate and insufficient data collection and usage. Common medical billing mistakes occur when patient information is not collected comprehensively and clinical procedures are not filed in a timely and accurate manner. Practice management solutions can offer comprehensive data collection services for holistic data within a medical billing software. Improper medical coding can be drastically reduced when patient data is collected efficiently and used toward medical billing codes. Finally, accurate and complete data erase the possibilities of duplicate claims, which can further delay payment processing. Automated information filling, such as social security numbers, demographic codes, etc., can speed up the medical coding process and procedures.   

7. Editing Features

Medical coding software should offer interactive and powerful editing features to enhance performance. The application of medical informatics can allow the tracking of every single claims transmission and verify its successful submission. Beyond this, medical coding companies can incorporate customized interactions, wherein questions can be answered, coding can be rectified, leads can be addressed, and coverage issues can be identified. Finally, automated medical coding solutions allow monitoring and tracking of each stage of a medical claim or batch from first logged to posted payment.   

8. Dynamic UX/UI

Clinical coding services are directly dependent on patient appointment scheduling details to ensure the accuracy of medical billing codes. Medical coding and billing can be significantly simplified through access to patient inflow, treatment details, appointment types, and revisits. Robust clinical coding solutions are integrated with remote health monitoring systems that depend on each other for accuracy. An easy-to-access interface, which shares a common platform for scheduling and billing, is the ideal component of an efficient healthcare payment system.   

9. Compliance 

You can safely call this feature the lifeblood of clinical coding solutions. Compliance strength should take precedence in clinical coding services among the many features. Without compliance embedded into hospital coding or any other form of medical coding, the risk of running into a lawsuit is high, and this can cause a harsh blow to healthcare RCM. Manually keeping up with updated medical laws is relatively difficult. Therefore, automation within the compliance aspect of your software is essential for maintaining HIPAA compliance standards.   

10. EHR Integration

A centralized database of patients has its advantages, but integrated health information systems work better for hospital coding. The benefits are much more when the clinical coding software has instant and uninterrupted access to the updated patient database through integrated health systems. Hospitals and other healthcare organizations must ensure that EHR/ EMR access is given to the medical coding and billing department to boost the revenue cycle for healthcare and offer holistic patient engagement systems. Finally, it allows access to medical records insurance eligibility, Medicare coverage, etc.   

Conclusion

Medical coding companies are faced with the constant irk of incorrect coding. The complex system of medical bills is owed to the complexity of accurate coding. Keeping up with updated codes, ensuring and double-checking the patient’s clinical processes to match the proper codes is no ordinary task. Medical billing services, very often, face the issue of complacency. Codes are not double-checked for accuracy, and old codes result in denied claims and reduced cash flow. Clinical coding solutions and automated coding software can greatly assist in mitigating medical billing errors. As medical billing companies attempt to streamline their services, robust coding software is the best way to stay ahead of the game.