Accurate medical coding is obviously essential to the medical billing process. But the critical role of technology in the coding process is easy to overlook. For hospital-based physicians, most of the information needed for billing exists in one or more systems: HIS, ADT, EMR, lab, CIS, etc. These systems are typically large, complex and customized. Therefore, sophisticated systems and workflows are needed to extract the information needed for medical coding and billing. 

For accurate medical coding, here are five technology-related questions to ask when assessing your medical billing department or your current/potential medical billing company. When it comes to medical coding, what you don’t ask about automated workflows and technology can hurt your bottom line!

     1. What would my automated workflow look like compared to my current one?

If you’re considering a new medical billing company, you want to fully understand the logistics of their proposed workflows. How would your current workflow be optimized? Is the company equipped to automate all current workflows?  What specific benefits do you have to gain? It’s wise to share your current workflow and request an outline showing how the new company would handle the process from start to finish. How would they enhance coding accuracy and efficiency – and payment turnaround times? You should see firsthand how an automated workflow would work and how it would create better outcomes for your practice. Get this visibility beforehand – not after you are converting and get surprised.

     2. Can you handle different types of workflows?

Make sure the medical billing company is in sync with your workflow regardless of what clinical information system, hospital information system or “bolt-on” technologies you are using today. Consider Pathology coding. There are often two workflows involved with pathology. While most reports come directly from hospital interfaces, there are often additional reports from ancillary systems or outside sources involving specialty testing. When these reports do not come directly from the hospital, a manual workflow may be required. You need to be sure the company has the capabilities to efficiently handle paper workflows when required. Radiology coding often has similar requirements.

     3. How do you flag problems or issues that arise?

When dealing with problems that arise, it’s essential for a company to have a dedicated system of checks and balances. A not infrequent example: a hospital changes its report format without advance notice. When these reports hit the interface, the information may not load. AdvantEdge has devised an entirely separate workflow to ensure that all files have been properly loaded, so the process moves forward without any glitches. This process scans reports before they are loaded to make sure the format is what was anticipated – or not. If changes were made to the format, they are flagged and stored in “error or exception” folders. The AdvantEdge IT department promptly contacts the hospital IT department or, if necessary, the healthcare provider to find out what was changed and why. It’s also essential to determine whether this was a one-time deviation or whether programming needs to be altered to accommodate permanent changes. 

 

     4. Is your staff adept at handling implementations?  

Make sure a medical billing company has solid expertise in handling all types of implementations. One of the biggest challenges during implementation is securing all necessary data – and failure to do so is what accounts for most delays. If employees at a hospital or clinic are not adept at releasing data to third-party companies, the process can take considerably longer than anticipated. AdvantEdge has the expertise to get complex interfaces up and running within a 90-day window. Even in complicated situations, AdvantEdge has the experience to secure all necessary data for smooth implementations with the utmost accuracy, efficiency and speed. 

     5. Do you have proprietary software dedicated to optimizing medical coding and billing?

A company with proprietary software focusing on the specialized requirements of physician coding and billing brings considerable value to healthcare providers. For example, AdvantEdge’s proprietary software can integrate with almost any interface or type of file, making it easier to interface with hospitals that rely on proprietary or customized systems. During the implementation process, our specialized software can be programmed to run reports by revenue code, location of service, payor groups or by other requested information to accommodate the specific needs of hospitals and healthcare providers. This high level of customer service is available to our clients because we own the software code. 

This flexibility also enables AdvantEdge software to quickly adapt to changes in medical coding, billing, and compliance regulations.

Given the importance of technology and automated workflows, we have put together an upcoming “bonus” blog with additional questions to ask about the capabilities of a medical billing company. So, stay tuned. Until then, keep up to date on AdvantEdge and its medical billing initiatives by visiting our LinkedIn page.