Revenue cycle and coding processes are essential in supporting clinical efforts to reduce hospital readmissions for primary care clinics. Accurate documentation, coding practices, and efficient billing processes ensure patients receive the proper care at the right time, minimizing the likelihood of readmissions.
Coding Practices That Contribute to Reducing Readmissions and Improving Outcomes
Documenting Social Determinants of Health (SDoH):
Social factors like housing, transportation, and financial stability significantly impact patient outcomes. Coders can support efforts to reduce readmissions by:
Using Z-Codes for SDoH: Including codes highlighting social barriers enables care teams to identify high-risk patients needing additional support post-discharge.
Improving Care Team Communication: Accurate documentation of SDoH allows care coordinators to address barriers proactively, helping prevent readmissions.
Coding for Chronic Conditions and Co-Morbidities:
Patients with chronic conditions are at higher risk for readmissions. Coders can ensure:
Accurate and Detailed Coding: By accurately coding chronic conditions, coders provide clinicians with the information needed to manage these patients effectively.
Regular Updates for Ongoing Conditions: Up-to-date coding on chronic conditions helps manage care more precisely, reducing the chance of overlooked needs.
Problem List Clean-Up: Helping provide clinicians insight into updating their patient’s problem list with the proper coding on co-morbidities allows them to select the best code based on the condition and eliminates overuse of unspecified codes.
Proper Use of Transition-of-Care Codes:
Coders play a role in tracking transitions of care, an essential component in preventing readmissions:
Billing for TCM Services: By accurately coding TCM services, practices can receive reimbursement for crucial post-discharge follow-up care.
Ensuring Continuity of Care Documentation: TCM codes support primary care providers in delivering structured follow-up care, leading to better patient outcomes.
How Revenue Cycle Managers Can Support Readmission Reduction Initiatives
Maximizing Reimbursement for Preventive Services:
Many insurance plans cover preventive services that can reduce readmissions. Revenue cycle managers can:
Identify Covered Services for At-Risk Patients: By understanding payer policies, managers can identify preventive services that align with readmission reduction goals.
Streamline Claims Processes for Preventive Care: Simplifying claims for preventive care services reduces delays in patient access to essential care.
Implementing Audits to Ensure Accuracy and Compliance:
Revenue cycle audits help catch documentation or coding errors that could lead to denied claims or missed follow-up opportunities. Consider:
Routine Coding Audits: Regularly auditing coding practices ensures compliance with payer policies, supporting quality initiatives.
Compliance Checks for TCM and Follow-Up Codes: Focus on codes related to care transitions to ensure they’re being used correctly and effectively.
Practical Steps for Coders to Support Care Transitions and Follow-Up
Consistent Documentation of Care Instructions and Follow-Up Plans:
Coders should prioritize accurate documentation of patient care plans and follow-up instructions to ensure continuity of care.
Use Detailed Discharge Summaries: A thorough discharge summary helps the next provider understand the patient’s needs, reducing the chance of miscommunication.
Documenting Patient Education Efforts: Ensure patient education sessions are documented, as these are critical for preventing readmissions.
Collaborate with Clinical Teams on High-Risk Patient Profiles:
Coders can work with clinical teams to develop profiles for high-risk patients based on coding data. Coding data can help stratify patients likely to need extra support, ensuring that care teams are alerted to potential risks.
Reducing readmissions requires a team effort, and coders and revenue cycle managers play a crucial role. Accurate coding and billing practices support care plans, helping patients achieve better outcomes.
At BCA, we offer auditing and consulting services to support your practice in maintaining compliance and enhancing the quality of care, with documentation review starting at $499 per clinician. Please contact us at info@bcarev.com to learn more about our tailored solutions and how we can help you optimize your quality initiatives.