Medical Coding Backlogs and How to Avoid Them

Complex regulations, under-qualified staff, and high staff turnover can create coding backlogs for your organization that can become costlier as time passes. Long-term, short-term, or even within a specialty, staff shortages mean you’re not optimizing the financial benefits that accurate, reliable coding offers your organization.

An increase in the volume of charts to be coded can create a coding bottleneck, which attracts unwanted scrutiny. A coding backlog has downstream ramifications regardless of whether it grew as the result of a positive decision, like expansion by acquisition or an increase in the number of patients or from challenges all providers experience, such as a shortage of staff, poor coder performance due to lack of training, or inefficiencies farther upstream in the revenue cycle beyond the influence of coding leaders.

Four Causes of Medical Coding Backlogs

–      Complex regulations that are constantly updated: What has always been challenging has become even more difficult due to the primary changes involving evaluation and management (E/M) codes, which became effective on January 1, 2021. This, along with other Centers for Medicare & Medicaid Services (CMS) changes, has made coding more challenging for even highly experienced coders.

–      Lack of qualified staffing: With an increase in patient volume and massive regulatory changes (ICD-10, MACRA, and more specifically MIPS, to name a few), the healthcare industry is experiencing a critical staffing shortage in both clinical positions and in the revenue cycle and coding departments. A lack of coders can cause greater strain on existing staff who are trying to keep up, which in turn can lead to higher rates of turnover, further exacerbating staffing issues and increasing the coding backlog.

–      Employee Burnout: A study published by Healthcare Finance suggests that RCM staff who were able to work from home during the pandemic often had to deal with unique challenges like finding the right space and accommodating their families and children. Many RCM staff also found themselves furloughed at the beginning of the pandemic and when they finally returned to work, staffing shortages forced them to work at a level which was sometimes above their experience level. These stressors have taken a toll on RCM staff, which has further compounded the turnaround time for coding and the contribution of medical coding backlogs.

Aging population: The Bureau of Labour Statistics indicates that the growth in our elderly population will lead to an increase in the demand for medical services. An increase in services for this population means an increased need for coders and billers to handle their claims. As the population continues to grow, the federal government will most likely need to adjust policies to address the increased costs of providing healthcare to these individuals. This means requiring a higher degree of proficiency with more complex coding and billing.

Coding Backlogs are extremely costly

Backlogs are costlier than they might initially appear. Coding backlogs are extremely costly because:

1.   Your cash flow is delayed and, as a result, you are either paying more interest expense on debt or missing investment income from the cash you should be holding.

2.   When you fall behind, you inevitably fail to code and bill some percentage of procedures.

3.   Work done under pressure often causes an increased number of errors, with A/R follow-up work requiring more time and effort.

4.    Organizations often don’t have enough time and resources to audit the process for completeness or stay current through consistent training.

How to tackle Medical Backlogs

Big backlogs require concerted, focused effort. While the major effort will always be to dig in and simply do the work, coding accurately and proficiently, resolving the cause of the backlog is equally important to prevent it from recurring, enabling you to focus on the one thing you want to do most, taking care of the ailing.

Here are some tips to try and tackle these kinds of backlogs.

–      Your coding team must be your extended team: Medical coding is not just simply selecting the right codes and using them for billing purposes. A medical coder must do research and apply payer-specific documentation, choose accurate procedural codes, choose accurate modifiers based on clinical scenarios, appeal denials with the necessary information, and conduct coding audits to ensure compliance with payer coding guidelines.

–      Be aware of Advanced Technologies: Medical coding has been revolutionized by the use of Electronic Health Records (EHR). In addition to the EHR system, there are also a variety of other technologies such as Computer Assisted Coding (CAC) solutions that can increase the accuracy and quality of medical coding, or CCI and LCD edits, which will enhance accuracy.

–      Coding Quality Auditing must be regular: Monthly coding audits can save your healthcare business a great deal of money, as well as time. Niche practices may require more frequent audits than others because of the complexity of medical coding.

–      Transparency in Communication: If coding services are outsourced, the provider and coding team must have transparent communication with each other to ensure that all procedures are documented properly. Coders should be notified immediately whenever there is a possibility of audit findings or changes to coding standards so that they can immediately modify workflows to improve coding quality.

–      Stay on top of healthcare changes: Updates to the CPT, HCPCS, and ICD-10 are performed annually. Your coders should know and understand all the recent changes in coding. It is also crucial that they understand what effect value-based care and new reporting guidelines will have on patient care costs.

To Summarize:

Big backlogs require concerted, focused effort to address. While the immediate response will always be to dig in and simply do the work and code accurately and proficiently, resolving the cause of the backlog is equally important to prevent it from recurring. Red Road can assist you with this, ensuring that you are not overwhelmed at the task and help you run your business smoothly, while also taking care of every aspect of medical coding so that you can focus on patient care.