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Latest CASE STUDIES
By AGS Health
July 23, 2022
The COVID-19 pandemic has had an unprecedented burden on healthcare systems worldwide. However, the pandemic has also accelerated the digitization of healthcare operations. This is especially true for hospitals and other primary care providers' billing and coding departments. With error-free, consistent documentation and claims processing becoming the primary factors for a sustainable revenue cycle for healthcare organizations, digitization is imperative to increase payer-provider synergy.
Medical coding has several objectives: to capture patient services, influence future medical decisions based on patient history, and submit accurate claims to payers for full reimbursement.
However, claims are frequently denied due to coding errors and missing documentation. Studies have noted healthcare enterprises lose $8.6 billion annually on claim appeals.
Claims are denied for various reasons, including incorrect or incomplete documentation, faulty diagnosis, and failure to meet filing deadlines. The following are the different types of claim denials:
According to HFMA (May 2021), 90% of all denials are preventable, and 2/3 of those preventable denials can be successfully appealed. To put the loss in perspective, every denied claim costs on average $31.50, which includes an initial fee of $6.50 for initial filing and a remarkable $25 for resubmission. Furthermore, the average price of appealing a denied claim is $118. Healthcare enterprises lose 3% of net revenue every year on claim denials alone.
Examples of common coding errors include:
Medical coding systems add significant value to healthcare enterprises and aid them in reducing claims denial. Enterprises must, however, follow these best practices to achieve the best results:
Providing proper and comprehensive documentation of provider services is one way to eliminate medical coding errors. This is where clinical documentation improvement (CDI) can be crucial for healthcare revenue cycles. Healthcare organizations lose revenue and credibility due to incomplete or inaccurate documentation of medical records. An accurate database is essential, and CDI is key.
Healthcare organizations are leveraging technological advancements to improve documentation and coding accuracy. Computer-assisted coding (CAC) software plays a pivotal role in enhancing coding productivity while improving healthcare outcomes. As a result, selecting the right technology solutions provider is essential. To achieve medical coding excellence and dramatically reduce claims denials, organizations must partner with a multi-dimensional and future-facing vendor.
AGS Health’s comprehensive suite of AI-enabled CAC solutions can help healthcare institutions improve their coding and documentation process and ensure negligible revenue losses from denied claims as the only fully integrated, born-in-the-cloud technology provider.
By using a hybrid approach that blends technology and outsourced medical coding services, staff can be used to validate codes and ensure providers are fully reimbursed.
Read AGS Health’s Hybrid Approach white paper for more details.
AGS Health is more than a revenue cycle management company–we’re a strategic partner for growth. By blending technologies, services, and expert support, AGS Health partners with leading healthcare organizations across the US to deliver tailored solutions that solve the unique needs and challenges of each provider’s revenue cycle operations. The company leverages the latest advancements in automation, process excellence, security, and problem-solving through the use of technology and analytics–all made possible with college-educated, trained RCM experts. AGS Health employs more than 10,000 team members globally and partners with more than 100 clients across a variety of care settings, specialties, and billing systems.