In the ever-evolving landscape of healthcare, efficient revenue cycle management is paramount to the financial success of organizations. The complexities of revenue cycle management often present challenges that hinder the streamlined operation of healthcare facilities. As a contract coder with extensive experience, I frequently encounter situations where organizations could significantly enhance their revenue cycle management processes, either by efficiently utilizing their internal staff or contract coders. In this article, we'll delve into the issues organizations face within their revenue cycle and explore practical solutions.

When you hear the phrase note bloat what do you think? I start envisioning a note that resembles a blown-up balloon ready to burst. Now that's a funny thought! But that's not really what it is. Note bloat happens when a medical document is overflowing with information that is not necessary for the treatment of the patient on a given date of service.

Wow! Where should I begin? If you have been in healthcare for any length of time, you are aware that there are many “interpretive differences” in how coding and instructional guidelines are applied. While most of the differences are between CMS and CPT, other payers and Medicare Advantage plans may choose to develop contractual agreements which side with CMS and/or CPT depending upon the situation.

Surgical lumbar decompression is a procedure that is commonly performed to relieve pressure on the spinal nerves in the lower back. This is typically recommended for individuals who are experiencing chronic back pain, numbness, or weakness due to conditions such as spinal stenosis or a herniated disc. Selecting the correct CPT for these types of procedures is determined not only by approach, but by the diagnosis the patient presents with. In this blog post, we’ll explore the coding options for the lumbar region from a posterior approach. We’ll begin by breaking down the basic mechanics of these procedures before diving deeper into the applicable codes and guidelines.

Out with the 95/97 Evaluation and Management (E/M) guidelines, in with the new and improved 2023 E/M guidelines - Sounds easy right!? While the intent to reduce provider documentation burden may have been accomplished, the learning curve for providers and coders is real! Don’t get me wrong, there are several advantages to the updated guidelines; however, there are still rules that seem more difficult to follow than they should be. Not to mention breaking out of habits developed since 1995! While there are a couple of new E/M guidelines that have me scratching my head, today I would like to cover the confusion of how and when to count the review and analysis of tests.

Have you ever considered utilizing Learning Management Systems (LMS) in your organization? As global connectivity has grown, there has been an ever-greater need for a way to distribute educational courses and other programs to a widespread digital audience. Out of this need grew Learning Management Systems, or L.M.S., a software application created for the documentation, tracking, reporting, and delivery of educational courses, training programs, and learning and development programs.

While it seems initial coding audits have become a common practice among healthcare organizations, the importance of continued and ongoing auditing has become lost and forgotten. Keeping up with ongoing auditing is crucial for any healthcare organization as this can prevent revenue from being lost and the amount of unwanted and unnecessary denials from increasing. This also gives healthcare organizations a chance to educate their coding specialists and identify if their coding qualities align with their organization’s quality standards.