Medical Coding: The Life Behind RCM

Revenue Cycle is a complete circle of steps that ensure a hospital is able to collect the maximum possible revenue on time. The cycle starts as soon as the patient steps in the hospital and ends with the patient being able to settle his or her bill. In between these steps, though, there are a lot of processes that take place.

Medical Coding

Medical Coding is considered to be one of the major factors in the success of a Revenue Cycle Management system. This process makes use of standardized codes in order to let other medical professionals know the detail of one account.

Its importance is heavily underscored in ensuring a successful Revenue Cycle Management as it allows for the timely reimbursement of claims for coverages. This is because medical encoding also oftentimes already screen clients for social security disability eligibility and such.

Generally, medical coding, regardless of who is using it, makes use of a number of internationally understood codes including ICD-9 CM, CPT-4, and HCPCS (Healthcare Common Procedure Coding System).

The Coding Process

In most cases, the process of encoding starts with the encoder accessing the medical records of the patient. They would then check the data and the corresponding documents in order to determine accuracy and completeness of information. These are batched, with the next point person assigning modifiers and codes depending on the requirements of the insurance provider. Accuracy of encoding has to be at 98% in order to ensure that claims are approved immediately.

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