For Medical Coding and Billing, Proper Training is Paramount for Success
The healthcare industry is a highly regulated industry, with good reason, as millions of lives are impacted by the quality of health care provided to patients across the country. However, is it possible that the medical industry may be regulated too much? How do the increasing pressures of new rules, new processes, and increasingly stringent regulations impact the millions of healthcare professionals who make up the medical workforce?
Some studies seem to indicate that the healthcare industry may be over-regulated, or at least too regulated for many healthcare workers to keep up without undue levels of stress and errors. The constant growth and change in healthcare regulations continually add layers of bureaucracy, causing stress on healthcare employees, to the point that they may feel disengaged and disconnected from their employers, which makes them feel insufficiently supported with enough training and resources to do their jobs well. In fact, hospitals in the United States may at a crisis point, with more than 56 percent of the workforce feeling that way, according to a 2017 study by CultureIQ, entitled “Engagement & Retention in Healthcare Workers.”
One relatively recent, and significant change in healthcare regulations at issue is the new ICD-10 coding system, which replaced ICD-9 in October of 2015. The new coding system nearly quadrupled the volume of diagnostic codes from 14,000 to 68,000, while procedure codes jumped more than 2,000 percent, from 4,000 to 87,000 codes. This has resulted in a 69 percent increase in the amount of time taken to process patient medical bills (17 minutes on ICD-10, vs. 5 minutes per coding on ICD-9).
The specificity of ICD-10 codes has led to misunderstood terms in the workplace, causing mistakes, overwork, and limited time to complete billing procedures. This results ultimately in a decline in reimbursements, and an increase in overtime costs, financially choking physicians, all while reducing quality of patient care, according to David Womack, president and CEO of Practice Management Institute (PMI), which provides education and training to medical office staff at hospital systems, medical societies, and educational institutions nationwide.
Though ICD-10 implementation promised streamlined processes, sudden exponential increases of new data can have the opposite effect, Womack adds.
Based on his experience in the healthcare staff training field, Womack says reported employee disengagement is partially a result of this over-regulation, combined with lack of training. Per Womack, such a substantial increase of data without accompanied training could prove to be a catastrophic combination for the healthcare industry—a monumental risk for an industry already rife with coding errors.
Mistakes Are Costly to the Healthcare Industry
Mistakes do not only cost the industry, and employers, a great deal of money in lost reimbursements. Errors also cost valuable time, and quality—directly impacting patient health.
When employees are hit with too many things at once that they don’t understand, they go into apathy and tune out – resulting in increased mistakes, errors, and a general lack of understanding.
Up to 80 percent of all medical bills contain mistakes, costing $68 billion in lost healthcare spending. Combined with an overload of new data, Womack says risk of errors increases tenfold.
Why is there such a high rate of billing mistakes? “The oversight exists on the payer side of claims,” Womack explains. “Private and government payers alike scrutinize claims for accuracy. When problems are found, claims are denied, and money is lost.”
What Is the Solution? How to Prepare, Engage Staff in Wake of New Regulations
The healthcare industry will likely become more heavily regulated in the future. Therefore, according to Womack, high-quality, ongoing staff training is paramount to maintaining a cohesive, engaged team and minimize preventable errors.
“An engaged workforce is a well-trained workforce,” according to Womack. “Coding and reimbursement staff with proper training contribute to the solution in the form of clean, efficiently expedited [health insurance] claims.”
Studies show that healthcare organizations with a highly engaged workforce perform more successfully on safety, quality, and patient experience measures, heavily influencing financial outcomes.
Womack adds that companies offering professional certification in medical coding, third-party billing, office management, and compliance, are helping set a higher standard in employment by providing up-to-date education and testing that assures each applicant’s complete understanding. The result being that physicians can focus their attention solely to patient care, translating to a better experience for the patient, all while ensuring the practice continues to be successful.
Furthermore, Womack warns against hiring untrained medical coders and billers. “One of the biggest risks of employing untrained coders comes when healthcare auditors find problems resulting in the recovery of large sums of money for things like billing for services not rendered, unbundling, upcoding, etc. Ultimately, the physician bears responsibility for signing off on all claims, but the staff may share liability for incorrect billing practices, if they knowingly submit false claims.”
Is proper billing and coding historically a challenge for medical practices? Yes, says Womack. “The complexity of the reimbursement process is a pain point for sure, Womack states. “Fighting for dollars [owed] to the practice can sometimes take precedence over the treatment of medical conditions in determining the sustainability of a medical practice. Coders who lack proper training add fuel to the fire,” he adds.
Not only can a lack of training for medical coders and billers impact the back office of a medical practice, it may also impact the overall productivity of the entire practice. “Well-trained coders and billers can improve the overall profitability of the practice by finding missed revenue opportunities and submitting claims for every dollar that is rightfully do. Well-trained staff leads to better employee engagement, fewer errors and [greater] overall job satisfaction.”