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How To Simplify the Medical Coding and Claims Process

May 18, 2023

The medical coding and billing process is one of the most complex functions for any medical front office. If you don’t get it right, it can lead to significant delays in payment for services rendered. Read on to learn how your practice can simplify revenue cycle management and submit more successful claims to insurance.

What Is Medical Coding and Why Is It Needed?

When a patient gets medical care, the provider typically bills their insurance company. The bill must include specific medical codes for the insurance company to know what it’s paying for. These codes stand for any of the following:

  • Treatments

  • Services

  • Medical supplies

  • Diagnosis

  • Other circumstances or conditions that caused the patient to need care or supplies

In short, it comes down to what care the practice provides and why. These standardized codes come from the International Classification of Diseases (ICD), which is maintained by the World Health Organization (WHO). Most (but not all) developed countries use this same coding system so that care is standardized, even across international borders. In the US, providers also use Current Procedure Terminology (CPT) codes which are maintained by the American Medical Association.

Why Is Medical Coding So Challenging?

As any medical practice is highly complex, the coding and claims process requires detailed understanding and experience. Medical coders must review everything the care provider did and said and why they came to their conclusions. They must then translate each step in the process into codes that tell insurers exactly what was done and why.

This may seem fairly simple, but various scenarios may have overlapping diagnosis codes, and providing the wrong one will result in a denied claim. Coders must understand how these codes work together to create a complete picture of the patient’s health care, then submit them with precise documentation for insurance claims to be accepted.

Incorrect coding or improper documentation can cause claims to be denied. If various procedures aren’t properly bundled, this simple error can look like fraud to insurance companies. Such difficulties can lead to a lengthy and time-consuming editing and resubmission process and result in revenue cycle management problems for the practice.

How to Manage Your Medical Coding

Medical coding can be highly complex, and even those with years of experience may sometimes find it challenging. Fortunately, software solutions exist today to help simplify the coding process and allow billing offices to code with far greater accuracy, leading to more successful medical billing.

Practice management and EHR tools like those from Office Ally can help you keep detailed records of everything that occurs during a patient visit. The medical coder can then determine which codes to use and have the +appropriate documentation to back up their conclusions.

The software can even help with electronic claim processing, simplifying medical billing even further. It can automate claims denial management, meaning that the computer handles some of the hardest parts of medical coding for you. Automated claims can then be reviewed by the medical coder, making their job far simpler and allowing them to increase the accuracy of claims.

Let Office Ally Help Simplify Your Claims Process

Office Ally offers advanced software to help you manage your practice and allow you to simplify medical coding and insurance claims. Our software options include the following: 

Service Center

Our Service Center is a clearinghouse to help simplify claim management from start to finish. We help you verify eligibility in real-time and submit claims electronically. We can correct misdirected claims and reduce turnaround times, shortening the revenue cycle for your practice. Forget submitting claims by phone, fax, or mail and improve efficiency with Office Ally’s Service Center. 

Practice Mate

Practice Mate is our free online practice management tool that can streamline your front and back office work. You’ll have a dashboard that lets you track revenue and accounting tasks. We’ll connect you to over 5,000 insurance companies at no charge. And you’ll even be able to access your practice’s records anywhere, at any time. 

EHR 24/7

Electronic health records are simpler than ever, with customizable clinical workflows and reliable patient records. EHR 24/7 will let you boost productivity across your entire practice. You can chart and manage accounts, oversee lab testing, and even submit electronic prescriptions through our system. It’s a powerful and flexible way to offer value-based care, no matter your specialty.

Revenue Recovery

For larger practices and health systems, our enterprise solutions help prevent and recover lost revenue easily. Our solutions offer reliable tools to ensure you and your staff are compensated for all the care you provide. As a result, you’ll see a boost in patient satisfaction alongside better staff retention when you adopt our Revenue Recovery system.

Payer Gateway

Our Payer Gateway solution connects health plans to providers, information systems, and clearinghouses. We have 22 years of experience in supporting such healthcare connections. We can support transactions including:

  • 270/271 benefits

  • 276/277 claims Workers comp

  • 835 remittance

  • Claim attachments

  • and much more!

Sign up today to take advantage of these and many other benefits available with Office Ally.