Where manual medical coding falls short

Medical coding is horrible.

It’s true.

For as long as healthcare professionals have needed to bill insurance companies, our medical systems have been drowning in a chaotic system of ICD, CPT, and E&M codes. When it comes to traditional manual coding, issues abound. Manual coding is slow, inaccurate, and cost inflexible.

Manual coding’s slow pace

First and foremost, manual coding is slow.

Generally, traditional manual coding takes five to seven days from claim generation to submission.

That is five to seven days between surgeries, treatments, and care being provided to a patient before the claim is even submitted to insurance.

Once submitted to insurance, claims are reviewed and validated. Those found to be incorrect are denied and sent back for review, further prolonging the process. Healthcare practices have to pay for services provided while they wait for claims to be processed and revenue to be delivered. This delayed revenue shortens the runway for practices and limits an organization's ability to operate efficiently and invest in innovations in patient care.

Missing the mark

The pace of manual coding isn’t the only part of the process that is detrimental to practices. Manual coding is much less precise than autonomous coding, resulting in an average denial rate of 30%. As noted above, denied claims further slow the revenue cycle and a study by Change Healthcare found that 65% of denied claims are never reworked.

Denied claims that are never revisited represent lost revenue for services that have already been provided. It’s like dining and dashing, but instead of patrons sneaking out when the waiter isn’t looking, the waiter walks up and announces, “Sir and Madame, unfortunately, we were unable to learn the cost of the wine, steaks, and creme brulees you just dined upon so we won’t be billing you. Have a lovely rest of your evening.” No other industry would accept not being paid for services and goods provided, yet the healthcare industry regularly provides care that is never billed.

Inflexible cost models

The COVID-19 pandemic showed us that the world could flip upside down overnight. While we hope there are no more worldwide pandemics on the horizon, there are more typical events and seasons that can cause changes in patient flows. Urgent cares, for example, tend to experience patient flow that peaks during the winter (often doubling in size) and troughs every spring. This leaves urgent cares and other healthcare providers in tricky situations where they must staff enough medical coders to handle surges in demand, but when demand falls they suddenly have high labor costs that aren’t proportional to revenue numbers.

Autonomous medical coding solutions often charge a flat fee per claim processed. This means that costs are always proportional to revenue i.e. If demand falls, cost falls and vice versa. It is a perfect allocation of resources that eliminates waste. Even in the extreme of a pandemic where patient flow falls to zero, costs would fall to zero as well. Manual coding demands overpaying for services not needed in order to be prepared for surges in demand that may never arrive.

Manual coding just isn’t cutting it

Manual coding is slow, inaccurate, and cost inflexible. Manual coding systems developed when machines were incapable of quickly, accurately, and cheaply intaking complex information and processing it. In today’s day and age, however, artificially intelligent solutions harness the most technologically advanced computing power in the world and direct it towards approaching medical coding in a smarter way.

Matt Lee is the Director of Marketing at XpertDox, a company on a mission to automate the medical coding process and improve access to clinical trials.

Still have questions? Get in touch with me via the contact page at XpertDox.com/contact and we can sit down and talk about autonomous coding solutions, how they work, and why they are better than existing processes. If you're interested in how XpertDox can radically transform medical coding processes by reducing denials, decreasing costs, and improving accuracy, please visit us at: www.xpertdox.com/xpertcoding