- Introduction
- Why Concurrent Coding?
- Concurrent Coding Deciphered: How It Stands Apart from Retrospective Coding
- How Does “Real-Time” Feedback Offer a Notable Advantage?
- Prime Benefits of Concurrent Coding
- What Can Go Wrong – Navigating the Challenges of Concurrent Coding
- Addressing the Challenges
- RAAPID Augments Concurrent Coding Efficiency to Align with Provider Expectations
- Conclusion
Imagine a healthcare setting where every detail of a patient’s record is reviewed in real-time, as care unfolds. This is the transformation taking place with real-time patient record reviews, where physicians, coders, and CDI specialists work in unison to ensure accurate, timely data capture.
Furthermore, concurrent coding initiatives open up new possibilities for innovation within CDI programs.
A survey by ACDIS reveals the following:
- 76% of organizations prioritize quality through real-time queries.
- 58% of organizations report enhanced collaboration between coding and CDI teams.
- 53% of organizations observe improved monitoring of quality indicators.
These efforts contribute to a proactive, streamlined approach to documentation across the board.
Why Concurrent Coding?
Unlike traditional retrospective reviews, which often happen long after discharge and may miss crucial info, concurrent reviews provide immediate insights that improve the accuracy of HCC capture and speed up the revenue cycle.
For many healthcare groups, adopting concurrent HCC coding represents a forward-thinking shift. With real-time feedback and insights, CDI programs can refine their processes, leading to more streamlined reporting and optimized risk adjustment. This proactive approach is setting a new standard for compliance and efficiency in healthcare, where accurate documentation is not an afterthought but an integral part of patient care.
Concurrent Coding Deciphered: How It Stands Apart from Retrospective Coding
Concurrent coding offers a transformative shift from traditional retrospective coding, enabling a more proactive, real-time approach to healthcare documentation and billing. While retrospective coding typically takes place after patient discharge and relies on second-pass or rebilling processes, concurrent coding allows healthcare teams to capture HCCs (Hierarchical Condition Categories) and other critical documentation components immediately, facilitating timely and accurate data capture.
Retrospective reviews often impede efficiency and reimbursement. With retrospective reviews, coding and documentation gaps are often identified weeks or months after the patient encounter. This delay results in missed opportunities for accurate reimbursement, inefficient CDI (Clinical Documentation Improvement) processes, and a burdensome rebilling cycle. Billing staff must refile corrected claims with payers, each of whom has unique requirements, and perform follow-ups to confirm the corrections, a time-consuming process that can strain resources and delay reimbursement.
How Does “Real-Time” Feedback Offer a Notable Advantage?
Concurrent coding certainly provides immediate feedback to providers, often within a day or two of the patient visit, allowing them to address documentation gaps promptly. This real-time feedback can help providers improve HCC capture rates, amend clinical notes, and ensure accurate coding, all while patient information is fresh in their minds.
By refining documentation in real-time, concurrent coding closes the knowledge gap between providers and coders, reducing the likelihood of recurring documentation issues that are difficult to correct once records are finalized in the EHR.
With a concurrent coding approach, hospitals can better capture the full scope and complexity of each patient’s condition, leading to enhanced reimbursement accuracy. Not only does this decrease the number of claim denials, but it also reduces the time spent deciphering denial reasons, recoding, and resubmitting claims. This proactive documentation approach not only supports provider education but also leads to a more efficient billing cycle, helping healthcare organizations to finalize accurate codes on the first pass and thus achieve more timely, streamlined revenue cycles.
Discover Real-Time Coding Benefits—Boost Efficiency and Compliance Today
Prime Benefits of Concurrent Coding:
- CDI Program Innovation: Concurrent coding plays a critical role in supporting Clinical Documentation Improvement (CDI) by counteracting workflow inefficiencies and productivity-centric priorities that often impede accurate documentation. Implementing a concurrent coding program allows CDI teams to prioritize clinical case reviews, using real-time monitoring to identify improvement areas that align with long-term objectives. This approach reallocates CDI time and resources, fostering collaboration between CDI, providers, and coders to streamline documentation and clinical processes. In fact, a survey by ACDIS highlights how such innovations—like quality case reviews, HCC assessments, and increased face-to-face training—enhance hospital performance. By embedding concurrent coding into workflows, healthcare organizations can achieve a unified approach to documentation improvement, driving both quality and efficiency.
- Mitigates Care Gaps: Closing care gaps with concurrent coding addresses the core disconnect between coders and physicians due to differing documentation standards. As documentation requirements grow, gaps in patient data capture become more pronounced, limiting the ability of coders to accurately reflect a patient’s health status. By implementing real-time review and coding of clinical documentation, gaps or errors can be identified immediately while the details are still fresh for physicians—before notes are locked in the electronic health record (EHR). This concurrent approach allows coders to address issues as they arise, avoiding the pitfalls of retrospective analysis, where errors tend to linger uncorrected.
- Speeds overall Coding Processes: With real-time concurrent coding, providers gain timely insights into their patient care data, which not only enhances the accuracy of coding but also provides a continuous view of current, predicted, and historical trends. This insight is crucial for understanding risk profiles and quality scores, thereby enabling more informed decisions that optimize care coordination and cost efficiency. Ultimately, this approach ensures a faster, more efficient coding process that closes care gaps, reinforces accurate billing, and optimizes reimbursement.
- Lowers Denial Rates: Real-time coding strengthens first-time accuracy, capturing the full complexity of patient encounters, which is critical for enhancing the billing cycle. A well-established concurrent coding process reduces denials, minimizes re-coding and resubmissions, and thus streamlines the revenue cycle.
What Can Go Wrong – Navigating the Challenges of Concurrent Coding
As discussed earlier, while concurrent coding offers numerous advantages for providers, it also presents certain implementation hurdles which are as follows:
- Increased Administrative Burden: Implementing concurrent coding systems requires substantial training and can strain resources, particularly in smaller practices already operating at capacity.
- System Integration Challenges: Merging coding systems with existing EHRs and practice management systems can be complex, often requiring ongoing technical support.
- Privacy and Security Concerns: Real-time data processing increases the volume of sensitive information, necessitating robust security measures to protect patient data from potential breaches.
- Higher Upfront Costs for Small Practices: Transitioning to a concurrent coding system can be financially burdensome for small practices, involving costs for new software, EHR upgrades, and staff training.
- Steep Learning Curve for Staff: Staff, especially those familiar with traditional coding methods, may face a steep learning curve adapting to new processes and technologies.
- Limited Flexibility with Complex Cases: Concurrent Coding can complicate reconciliation in complex medical cases requiring multiple specialists, increasing the potential for disputes over claims.
Addressing the Challenges
Successful implementation of concurrent medical coding requires careful management of the associated challenges to maintain positive patient relations. Despite the odds, healthcare providers looking to transition to concurrent coding can navigate these challenges successfully by prioritizing careful planning, thorough training for staff, and investing in reliable technology.
RAAPID Augments Concurrent Coding Efficiency to Align with Provider Expectations
Our Prospective suite of solutions is crafted to streamline audit-ready documentation and guarantee compliance with CMS regulations.
By harnessing historical clinical data, cNLP, and advanced analytics, we facilitate the precise real-time capture of codes. This concurrent coding approach not only mitigates compliance risks but also enhances patient outcomes and increases reimbursement opportunities for providers.
Below is how we do it:
- Prospective Pre-Visit Solution: Historical insights derived from 360-degree longitudinal data support a higher degree of documentation accuracy, reducing the likelihood of omissions that could impact compliance. Thus, using AI insights from past patient data, our Prospective Pre-Visit Solution enhances annual visit planning.
- Point of Care Prospective Solution: Our EHR-agnostic Prospective Point of Care Solution directly brings actionable, real-time insights into the patient encounter. By identifying and highlighting care gaps within the EHR during visits, our solution enables physician teams to document all chronic conditions, promptly, ensuring immediate code capture. This concurrent coding approach significantly reduces the risk of penalties and facilitates accurate, timely documentation that aligns with CMS requirements.
- Post-Visit Pre-Claim Audit Solution for Compliance Assurance: RAAPID’s Prospective Post-Visit Pre-Claim Audit Solution empowers providers to add ICD-10 CM codes and audit interim claims for accurate reimbursement, enabling them to deliver care. It seamlessly integrates within the EHR workflow, ensuring documentation completeness and precise claims creation, safeguarding against potential compliance issues.
Through this multi-faceted approach, we enable healthcare providers to maintain audit-ready documentation, achieve coding accuracy, and uphold CMS standards, reducing the risk of penalties and ensuring financial sustainability.
Conclusion
In a world of evolving healthcare needs, concurrent coding revolutionizes how providers capture ICD-10 codes and care for patients.
By implementing real-time data reviews, which was impossible with traditional retrospective coding, and thus leveraging RAAPID’s advanced solutions, healthcare organizations can embrace a proactive approach that drives documentation precision, minimizes revenue cycle delays, and enhances compliance. Through innovations like our Prospective suite of solutions, providers achieve audit-ready, comprehensive documentation, ensuring patient records accurately reflect care at every touchpoint—a true transformation for patient outcomes and organizational success.
Source
Embrace concurrent coding with RAAPID
