Health System Coding Services

Hurdles Facing Health Systems

1 million claims a year – just one of the challenges that Health Systems face in managing their revenue cycle. Add to it an average 30-day delay in receiving payment and a 15% denial rate, and you have the recipe for a perfect storm. It is somewhat unnerving to know that denials and late payments collectively cost Health Systems an average of $15 million/year.

The best way to solve this problem lies in ensuring accurate coding and billing functions bby using well-trained and skilled resources.

This is where we come in.

Something that we pride ourselves on. For close to two decades, Sunknowledge has been assisting healthcare providers across the US with trained and skilled, fully certified medical coders. Building an in-house coding desk can take a lot of cost and time. With Sunknowledge, healthcare practices now have a convenient and instant access to a vast pool of medical billers, coders and other RCM personnel – available for work at a remarkably low rate.

The Complex World of Medical Coding

Coding for healthcare services is a highly specialized field of work. The following are some of the elements and guidelines that form part of a successful medical coding continuum.

Current Procedural Terminology (CPT):

• Standard code set for billing medical procedures.
• Ensures the correct coding of each procedure performed.

Healthcare Common Procedure Coding System (HCPCS):

• Used to bill for non-physician services like laboratory tests and durable medical equipment.
• Ensures the correct coding for these services and products.

International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM):

• Used to diagnose patients’ conditions.
• Ensures the correct coding for each diagnosis.

National Correct Coding Initiative (NCCI):

• Edits to prevent inappropriate coding combinations.
• Adherence ensures accurate billing.

Local Coverage Determinations (LCDs):

• Policies used by Medicare contractors to determine coverage.
• Awareness of applicable LCDs is crucial for accurate billing.

Medical Policy Bulletins (MPBs):

• Provide information about Medicare’s coverage policies.