6 benefits of dedicated outpatient technology
Pre-bill OP technology benefits organizations in many ways, including the following:
1. Ensure integrity of Chargemaster and HIM coding relationship. Technology can provide the synergy between the “hard” charge codes, and “soft” HIM coding to help ensure the accuracy of both.
Why this matters: Coding errors (missing/duplicate coding on the charge or HIM side, inaccurate modifier assignments, and other problems) can be caught before lost revenue and denials occur. And hard codes are not always visible or easily presented to coders, so automated technology can help identify issues here.
2. Preventing missed HCCs. OP technology helps ensure that all HCCs are documented and coded at every visit and at least on an annual basis. It allows organizations to analyze historical information and code patterns to look for code omissions and opportunities for additional specificity.
Why this matters: Accurate and comprehensive HCC capture equates to revenue integrity as well as accurate RAF scores that organizations can use to ensure the proper acuity of their Medicare Advantage (and other) patients are documented and codified. These variables also support value-based incentive payments, establish benchmarks and budgets for Accountable Care Organizations, help identify and address care gaps, and more.
3. Ability to review large volume of cases. Using automated pre-bill analysis, organizations have the ability to analyze coding accuracy for key categories of outpatient claims before they go out the door and flag questionable content so coders and auditors can review those cases.
Why this matters: Organizations can develop a proactive strategy to reduce revenue leakage and improve compliance from this growing segment of business. In addition to confirming compliant revenue capture quickly and efficiently, they can also identify coding and documentation accuracy trends that would have otherwise gone unnoticed. Using this information, they can develop educational and process improvement plans accordingly. This is especially helpful with the issues from hard-coded elements, many of which are charge-oriented and managed at the point of service.