Correct and complete reimbursement from payers begins with accurate and complete coding of the services performed and supplies consumed by the facility and its staff in patient treatment.

  • Is your DNFB within best practice standards?
  • Is there a regular independent QA process of coding?
  • Are all coders certified?
  • Do you have significant compliance concerns within coding?
  • Are you adequately staffed and do you have a defined plan for the ICD-10 Transition?
  • Is coding part of your global revenue cycle review and strategy?


Business Issues

Accurate and compliant coding optimizes hospital cash flow and the quality of your efforts can mean the difference between reimbursement and claim denial. However, many smaller community and rural facilities in limited labor markets and acute-care facilities, struggle to find, train, and retain experienced hospital coders. Coding processes are complex and change frequently. Adhering to and keeping up with CPT, HCPCS, and ICD-9 (soon to be ICD-10) guidelines represent a serious challenge for even the most sophisticated facility.

While a nationwide market of "traveling coders" has sprung up around the country to provide contract services, these temporary solutions rarely offer the quality and continuity required to ensure your facility receives proper reimbursement.

Best Practices

Foster a positive relationship between providers and coders

This is likely the most important step in setting the course for best practices.  Certified coders have a specific skill set that includes an understanding of anatomy and physiology, pharmacology, and medical terminology.  Setting up a team that consists of coders, physicians, and department heads, who meet regularly to discuss obstacles encountered and

Demand the best

Coding professionals, certified or otherwise, must be well-trained and able to weed through vast amounts of information to find what is accurate and substantiated. Now more than ever, organizations should be evaluating their coders to ensure that they have the experience it takes to be the best at their jobs. Certified coders are preferable; however, an organization can find a valuable asset in a coder who can not only assign codes, but reiterate a logical line of thinking in their coding choice, cite coding guidelines, and use only reputable sources.

Put it in writing

Despite the fact that coding seems to be black and white on the surface, there are many gray areas. Even when published guidelines exist, there may be a difference of opinions between fiscal intermediaries and payers on the correct interpretation of the guidelines. Providers and organizations have the choice about which to follow, and can even follow both, which is why it’s important to put into writing which will be followed. This ensures that both providers and coders know what they need to do, and that quality assurance checks are fair and consistent.

A well-written coding best practices plan should address not only which E/M guidelines should be followed, but also includes items such as the query process, guidelines for adding addendums to records, timelines for dating and signing records, and how to react to external audit requests to name a few. Written plans provide a clear set of instructions for physicians, coders, quality assurance analysts, and compliance team members. Additionally, they provide added benefits and resources when dealing with external auditing organizations.

Provide education and resources

Education for all levels of staff is essential. Every year, there are numerous changes, additions, and deletions to CPT. Each year, professional organizations provide in-depth guidance on these changes, while organizations such as the AMA and CMS provide written guidance on LCD’s and NCD’s.  Resources such as CPT, HCPCS, and ICD-9 (soon to be ICD-10) books must be updated regularly. EHRs must be regularly updated to reflect these changes to ensure that data from this resource is accurate.

Monitor for quality, teach new concepts and reinforce good behaviors

The quickest way to ensure that coding is up-to-speed is to perform regular quality checks. The use of auditing - even in small quantities - can provide insight to the documentation practices of physicians, nurses, and other clinical staff.

Documentation reviews can detect issues such as lack of signed orders, missing dates, insufficient documentation to support specific codes, and lack of specificity for diagnosis codes -all of which can have a potentially negative impact on compliance and revenue. Coding reviews ensure that analysts are capturing the data required for a clean claim, and that coders are capturing all procedures.



Value Added Coding Services

In nearly every survey, CEOs cite cost reduction as their number one priority, followed by patient safety and reimbursement. As a priority, reimbursement has emerged as being increasingly important. The criticality of a healthy bottom line, coupled with the changes propelled by ICD-10, place the importance of medical coders and accurate coding at the center of the financial health of every facility. <more>


How does your facility compare nationally with other facilities of your respective size?

re|solution is an expert in rural, community, and critical access hospitals, providing superior accounts receivable management, revenue cycle analysis, training, charge capture reviews, interim staffing, and an array of other business office services.  If you are interested in knowing how the performance of your business office compares with demographically similar facilities and where your opportunities exist to increase CASH. Please complete the form below and return it to us by fax or e-mail.  In return, we will provide you with a free benchmarking analysis.  We will also make ourselves available for a discussion and explanation of the data. You may view a Sample Report.

Benchmark Indicator Analysis

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Case Studies

Dallam-Harley Counties Hospital District increases cash and reduces expenses

In partnership with re|solution, Dallam Hartley deployed re|store™. re|solution placed a Revenue Cycle Manager onsite to assist with training current staff, securing additional staffing, stabilizing the DNFB and billing. The staff worked aggressively to meet milestone goals.

Ohio Valley Medical Center and East Ohio Regional Hospital find over $16 million in Net Revenue

Ohio Valley Medical Center deployed re|assess™ complemented by an experienced re|solution BOD to assess staff and staffing levels, provide training and accountability. The re|solution proprietary tools were utilized and left behind for sustainable improvement and success.

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