Clinical coding Optimization: Is Resistance Costing Money?

Individual physician practices may be lagging behind facilities when it comes to clinical coding implementation and the software that makes it possible. The hesitation to implementing the software is costing coding efficiency and the reimbursements that are withheld because of preventable errors that are made. The cost of errors is in the millions of dollars, but there are methods to preventing these errors.

Computer-assisted coding software basically acts like spell check does in a Word document: the information that is input is run by the coder through a database, alerting the coder if a mistake has been made. It also lets the individual know if additional documentation could possibly code the chart to a higher specificity. Ensuring that there are as few errors as possible results in bigger reimbursement, which means the physician receives a bigger payout.

But why do practices resist a new technology that could help them hang on to money that they are entitled to?

The short answer is that the upfront cost is high. Even though the benefits have been demonstrated and ROI has been proven, some physicians are still hesitating whether or not to make the move, especially now that ICD-10 has been delayed until 2015. An experienced healthcare consulting firm can help with ICD-10 implementation. While there are many practices and facilities ready, there are many that are not and this is why the delay has been granted.

Slow Audit Periods: The Perfect Time to Upgrade?

The success of a practice is directly related to their use of coding technology. When a practice is more efficient and accurate, the potential for greater reimbursements and fewer audits increases. This is an opportunity that many practices do not need to miss out on.

Between October 2013 and April 2014, there has been a suspicion of Recovery Audit Contractors (RACs) request. Before, RACs were allowed to take back a large number of physician reimbursements because of coding errors, many of which an automated error checking software could have prevented. This translates into major losses for doctors, thus hurting their bottom lines.

Although the RACs are suspended for the moment, physician practices that resist the new technology will not be able to keep up with very demanding payers. This is especially true when ICD-10 finally makes its way into the day-to-day operations of coders and medical billers. ICD-10 is going to be highly involved, ensuring the accuracy of coding in order to reduce errors. Errors cost the healthcare industry a great deal of money every single year. By reducing costs related to errors, the money saved can trickle down to the patient or at least slow down how quickly the cost of healthcare increases each year.

Overcoming Coding Optimization Challenges

The consensus is that physicians and facilities need to embrace the new technologies, especially since compliance is something that is becoming mandatory. While compliance may seem difficult, a healthcare consulting firm experienced with helping practices implement new systems can be beneficial. Basically, moving forward with clinical coding optimization will lower the cost of resistance. Yes, the initial cost can be rather frightening, but it pays for itself again and again through reimbursements.

It is also important for physicians and coders to keep in mind that there are and will be a large number of documentation challenges. Computer assisted coding can make it easy to code correctly and “upcode” when documentation supports it. If the physician is audited and it is found that medical decision-making doesn’t exactly back up a diagnosis, the auditor will most likely crack down on the physician. This is something that weighs heavily on the minds of doctors – they don’t want to document in a way that they end up losing money through reimbursements.

The balance can be hard to achieve, but with the help of a healthcare consulting firm, clinical coding implementation can be easier. That way the balance that is desired can be achieved and the proper reimbursements received. So between now and October 2015, physicians and other facilities that have yet to implement clinical coding optimization can in order to be completely ICD-10 compliant. This extension will also allow those who are ready to fine tune their systems so that everything runs as smoothly as possible, preserving employee morale and the patient experience.


Clinical coding optimization can save a lot of money in lost Medicare reimbursement. To see if you are in compliance or to take the first steps toward compliance, MD Pro solutions can help. Call us at 508-946-1665 or fill out our contact form so someone from our office can contact you.