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Making The Case For Single-PathCoding

Making The Case For Single-PathCoding

There are universal best practices used in all types of information systems. One of these approaches is known as the single source of truth (SSOT) approach. In essence, this approach is a structure that creates master data that is located in one source but accessible from any location. As the master data is updated, this update is immediately available through all systems pathcoding that are linked to the master data.

In healthcare, this is known as single-source medical coding or single-path coding. It is not new, but the stress on systems that began in 2020 with the onset of the COVID pandemic highlighted how valuable this approach can bein the healthcare system.

The Practical Side

There are different ways in which a single source of truth is used in the medical field. Daily use of the SSOT is in the patient’s EHR (electronic health record). When the information in the EHR is updated by anyone with access, that data is immediately available to the healthcare payer and anyone else with access to the patient’s care chain.

In traditional and commonly deployed medical coding systems, there is no single source of truth. The process typically includes the physician or other designated professional coder capturing data about clinical services, while facility coders record charges for any other resources, including prescription medications, medical supplies, and the use of specific equipment.

This results in two sets of medical coding professionals working on the same record. In turn, this increases the risk of coding errors, either duplications or omissions, as well as a lack of data sharing in the chain. These types of issues create challenges with increased claim denials and problems with delays in the revenue cycle.

The multi-source medical coding models also requires additional staff, with two sets of coders require for each claim. While many healthcare systems still use this method, it is increasingly problematic with higher claim volumes combined with shortages in all staffing levels within healthcare systems.

Early Implementation

Two large healthcare systems were early to use the 2015 ICD-10 coding mandate. The University of New Mexico Hospitals and the University of California San Diego Health both began using single-coding and found an increase in clean claim rates and also a 74% increase in productivity in coding.

This is combined with a decreased number of professional coders required, reduces coding variance across the facility, and provides a verification that all data is entered at the coding source.

There are challenges to consider when moving to a single-source coding model. Some of these challenges are easily managed, while others are more problematic. Working with a BPO (business process outsourcing) and RCM (revenue cycle management) partner can manage both the simple and the challenging aspects of single-path coding.

Obstacles and Solutions

Many in-house coders lack the big picture knowledge of coding across the healthcare system. To implement single-pathcoding, the coders must have experience, training, and understanding of state and federal regulations for both physician and facility single-path coding.

In addition, healthcare systems must design a system or infrastructure that creates a pathway for the data to move from the single coding source. Currently, multi-source coding systems are not set up to accommodate this type of data flow.

Choosing an RCM partner or solution provider that offers single-source coding is a step forward for any healthcare system. In choosing these partners, it is criticalto ensure the service provider has the ability to manage the process, including having professional, certified coders that are American Health Information Management Association (AHIMA) or the American Academy of Professional Coders (AAPC).

The RCM partner must also be knowledgeable and stay current on all medical coding requirements at both a state and federal level. These can change rapidly, so the provider should be focused on continual training for coders. The same is true for understanding payer formats to maximize clean claims and reduce denials.

Look for partners with a focus on state-of-the-art technology and setting high benchmarks for productivity, accuracy, and scalability. Professional coders should be able to reach standards of 95% and above.

Finally, consider with the RCM partner can offer in addition to single-source coding. The top providers offer a full suite of services, including customized revenue cycle management, patient experience, and health information management solutions.

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