The healthcare industry is constantly evolving, driven by advancements in technology, changes in regulations, and the ever-growing demand for more efficient and accurate healthcare services. One crucial aspect of this evolution is the transformation of medical coding, which plays a critical role in the healthcare industry, ensuring that medical information is accurately documented and translated into universal codes for billing and data analysis. As we look ahead, several key factors are poised to shape the future of healthcare medical coding.
One important factor is prospective and concurrent coding.
Prospective validation is a crucial aspect of medical coding that plays an important role in ensuring accurate and reliable data. In simple terms, it involves the validation of codes before they are used for billing or reporting purposes. This type of validation occurs in real-time, during the initial encounter or visit with the patient.
Concurrent validation is a crucial step in the medical coding process, ensuring accuracy and consistency in coding practices. This type of validation takes place concurrently or simultaneously with the patient encounter, allowing for immediate feedback and correction if needed.
During concurrent validation, coders review the documentation provided by healthcare providers while the patient is still receiving care. They compare this documentation to established coding guidelines to ensure that accurate codes are assigned for diagnoses, procedures, and other relevant information.
Annova’s unique approach towards Concurrent and Prospective HCC coding:
PROSPECTIVE DEEP-DIVE
- Performing a Pre-Encounter review of the member's past medical records (up to two years), incorporating suspecting methodologies, and providing provider education in advance of the member’s next encounter, prompting the provider to address any Missing, Questionable, or Poorly documented conditions clearly and completely.
POST-CLAIM REVIEW
- Review the medical record for a single encounter within 7 days of the encounter/claim to
capture/validate risk adjusting diagnoses and provide coding feedback.
PRE-CLAIM REVIEW
- With access to the provider EMR, the senior coding staff can review the encounter note
and the provider-selected codes within 24-48 hours, supplying corrected codes and
query-style feedback to the provider before the claim is finalized and out the door.
Conclusion
Experts say that combined prospective and concurrent review ensures accurate
documentation and claims. Proper implementation of prospective reviews significantly
increase the likelihood that the physicians will get the documentation right the first time,
which decreases back and forth communications, corrections, and overheads during the
concurrent stage. Additionally, detailed concurrent review can reduce or eliminate the
need for retrospective reviews.