Unraveling the Reasons Behind Medical Coding Backlogs
High-quality coding is the foundation for timely, accurate reimbursements; an issue during the coding process can lead to time-consuming rejections and costly denials. This, in turn, creates a cog in the entire revenue cycle that leads to backlogs, lingering days in A/R, and delayed reimbursement. We’ve put together four unexpected causes of medical coding backlogs and what organizations can do to address them.
More complex regulations
What has always been a challenging role has become even more difficult due to what Revenue Cycle Intelligence says is “the greatest change to the Medicare Physician Fee Schedule in about three decades.” The primary changes involve evaluation and management (E/M) codes, which became effective on January 1, 2021. This, along with other changes by the Centers for Medicare & Medicaid Services (CMS), has made coding more challenging for even highly experienced coders.
Lack of qualified staffing
The entire healthcare industry is experiencing a critical staffing shortage, and not just in clinical positions. Revenue cycle staff are also in high demand. Lack of coders can cause greater strain on existing staff who are trying to keep up. This, in turn, can lead to higher rates of turnover, further hampering staffing issues and increasing the coding backlog.
When it comes to recruiting and hiring coders, providers are facing another challenge: A more competitive market.The COVID-19 pandemic has caused a mass migration from in-office positions to work-from-home positions. Now that roles like billing and coding can be done from home, these professionals have broader opportunities to find a best-fit position. In this way, providers aren’t just competing for local talent; they’re competing with nation-wide talent. If salaries and benefits are better at a facility in another state where remote coding is accepted, coding professionals who prefer to work from home are more likely to take those positions, leaving local facilities with a smaller applicant base to choose from.
We hear a lot about pandemic-related burnout in front-line workers. However, the burnout has extended into other areas as well. An article published by Healthcare Finance suggests that revenue cycle staff who were able to work from home during the pandemic often had to deal with a challenging home environment like finding the right space and dealing with everyone’s families and children. Balancing work and home life added to the stressors of the pandemic. The article also points to the fact that many revenue cycle staff found themselves furloughed at the beginning of the pandemic and when they finally returned to work, staffing shortages meant many were doing work “above their experience level.” Together, these stressors have taken a toll on revenue cycle staff, further compounding the turnaround time for coding and contributing to medical coding backlogs.
The Bureau of Labor Statistics indicates that the growth in our elderly population will increase demand for medical services. Older individuals typically have multiple—and more complex—chronic conditions that require more care to manage. An increase in services for this population means an increased need for coders and billers to handle those claims. As this population continues to grow in numbers, it is likely that the federal government will need to adjust policies to address the increased costs of providing healthcare to these individuals. This means more complex coding and billing that require a higher degree of proficiency. Simply keeping up with regulatory changes at both the federal and state level is already challenging for the best of coders.
If your organization is like most health systems, these challenges are not new to you. Outsourcing or augmenting your coding needs with a third party can mitigate these challenges without having to add staff or expensive technology and can help reduce medical coding backlogs and improve the speed of the revenue cycle overall.
When looking for a partner, choose one that can demonstrate a high-level of coding accuracy. Doing so helps enhance revenue cycle efficiencies by reducing rejections and denials, improving regulatory compliance, streamlining daily reconciliation, and providing more timely, accurate reimbursement.
Omega Healthcare should be considered for your vendor of choice. We have more than 6,000 medical coding specialists on staff who code more than 118 million charts each year. Our team leverages artificial intelligence, OCR, and natural language processing to deliver faster claims turnaround, more accurate coding, and fewer rejections and denials. In addition to coding for hospitals and physicians, our team also has expertise in ambulatory surgery centers (ASC), E/M (inpatient and outpatient), radiology and interventional radiology, emergency department, pathology, EMS, anesthesia, primary care, urgent care, home health, hospice, and IP DRG – and more.
Omega Healthcare processes more than 118 million charts each year, we achieve greater than 95% audit accuracy, and we process nearly 16% of all emergency medicine charts in the U.S.
When it comes to risk adjustment and HCC coding review, Omega Healthcare can help there too. We have 800 HCC coding specialists who code 635,000 charts each year. Our coders have the level of expertise needed to help providers prepare and submit accurate and complete data in advance of CMS deadlines. We can help you achieve your compliance goals and optimize reimbursement with less effort.
Omega Healthcare’s services are technology-enabled via proprietary solutions that help us achieve the highest levels of accuracy and quality. Automation platforms for our mid-cycle services include:
- OSCAR (Omega’s Suggestive Coding Augmented Routine) improves coding accuracy and speed with real-time monitoring and SLA alerts.
- OSCAR WORKFLOW is an inventory management tool that allots batches to coders and QAs, improving accuracy and eliminating manual calculation errors.
- OSCAR Audit Module streamlines the auditing process, improving accuracy of charge entry, payment posting and coding audits.
The bottom line
The pandemic has had a significant impact on expenses related to staffing shortages and supply chain issues. According to an article in Revenue Cycle Intelligence, total expenses per adjusted discharge have increased 43.5% since January of 2020. Labor expenses have risen 57% and non-labor expenses have risen 35.%. The bottom line is that providers cannot afford to compromise their revenue stream due to coding backlogs. Partnering with revenue cycle experts like Omega Healthcare can help providers better navigate these challenging times by delivering more effective coding and more timely, accurate reimbursement.
 “Top Challenges, Opportunities of Medical Coding and Billing,” RevCycle Intelligence, February 5, 2021
 “To keep cash flowing in today’s tight labor market, revenue cycle leaders are using technology — 3 experts answer 3 Qs,” Becker’s Hospital Review, November 16, 2021
 “Revenue cycle directors deal with a competitive market for staff as elective care returns,” Susan Morse, Healthcare Finance, June 21, 2021
 “Occupational employment projections to 2022,” U.S. Bureau of Labor Statistics, December 2013
 “Get the Facts on Healthy Aging,” Center for Healthy Aging for Professionals, National Council on Aging, January 1, 2021
 “Hospital Revenue Fell as Expenses Increased Amid Omicron Surge,” Victoria Bailey, RevCycle Intelligence, March 1, 2022