PMI: Relationship Between Medical Coding, Provider Reimbursement and Patient Satisfaction Scores Here to Stay

Share Article

Patient satisfaction scores as part of the Merit-based Incentive Payment System (MIPS) may be negatively influenced by the use of incorrect medical codes. To prevent bad reviews and help ensure collection of appropriate revenue, healthcare organizations should employ certified medical coders who are up-to-date on the latest training.

The new value-based healthcare scoring models are in full swing, and provider offices that score poorly on documentation and coding will not only miss out on bonus incentives but may also lose ground in terms of patient satisfaction scores that will negatively impact reimbursement, according to industry leader Practice Management Institute (PMI).

The medical codes that document patient encounters for third-party reimbursement also affect patient satisfaction scores through MIPS. Protecting practice revenue and keeping patient satisfaction high is a delicate dance. Healthcare providers that employ certified medical coders and medical compliance officers, are more likely to stay on top of current guidelines.

“MIPS-MACRA-QPP, it’s not about the acronyms as much as it is about good data. If you are collecting and reporting good data, the right data, then everything else is going to turn out ok,” said David T. Womack, President/CEO of Practice Management Institute.

The documentation and codes are what drives third-party payers and quality payment measures. Womack said that practice that focus on improving clinical documentation and coding are in the best position the practice to thrive with the new reimbursement models.

However, when medical documentation errors lead to incorrect medical codes assigned to a patient’s medical record, the consequences can be far-reaching. Consistent coding errors can trigger medical audits which, if could lead to fines and sanctions that have devastating results.

“If we can show physicians and coders why this is an important part of delivering healthcare, they are more likely to buy-in,” said Womack. “We cannot improve data reporting without clinician participation, both on the documentation side and reporting the right codes.”

Beyond the financial costs, practices using improper medical codes are at risk for declining patient satisfaction scores. Many healthcare professionals believe that patient satisfaction scores are simply tied to the patient’s perception of their own care experience,(1) but satisfaction surveys are frequently returned to practices with negative reviews if patients receive large, unexpected medical bills as a result of poor coding practices.(2)

Patients faced with unexpectedly large medical bills, regardless of the level of care they received, are going to have a negative reaction to that experience. That is why it is essential for healthcare organizations to employ Certified professionals, knowledgeable in handling difficult claim situations, are in a better position to communicate with patients understandable terms. The reality is that part of healthcare provider reimbursement is determined directly by patient satisfaction scores—the lower your scores, the less you get paid.

Continuing education for certified medical coders and reimbursement staff is essential in ensuring that staff members are up-to-date on the latest guidelines. A well-trained office staff is much better equipped to navigate medical coding regulations, thus helping to ensure compliance and good patient relations.

“It’s not like someone learns medical coding and then they’re done; coding requires continuing education to stay on top of the latest rules and requirements. Healthcare practices that employ certified coding staff enjoy greater compliance, happier patients, and more success in obtaining their share of profits,” says Womack.

About Practice Management Institute (PMI):
For over 30 years, Practice Management Institute (PMI) has helped physicians, hospital systems, medical societies and educational institutions provide comprehensive education and training to medical office staff nationwide. By offering a variety of educational programs and professional certifications, PMI helps to build the competency, compliancy and effectiveness which assure the continued success of its clients.

Since PMI’s formation in 1983, over 20,000 individuals have earned certification in one or more areas of expertise. PMI is recognized by both the Centers for Medicare and Medicaid Services and the Department of Labor for training in medical coding, third-party billing, office management, and compliance. PMI training helps ease the burden of running a successful medical practice by way of thorough education and up-to-date training for non-clinical staff, allowing physicians to focus on patient care to improve the experience of the patient. For online coding and compliance training at affordable rates, visit http://www.pmimd.com/onlinetraining.

About David Womack:
David Womack, president and CEO of PMI, has been instrumental in PMI’s continued success since 1991. He has helped PMI transition into a cutting-edge leader in medical office staff education and training while developing key relationships with healthcare organizations, hospitals, colleges and medical societies across the country. His commitment to excellence has helped PMI become an industry leader recognized by both governmental organizations and healthcare systems across the country.

Sources:
1.    HCAHPS: Patients’ Perspectives of Care Survey. Centers for Medicare & Medicaid Services. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HospitalQualityInits/HospitalHCAHPS.html
2.    Impacts of ICD-10 on Patient Satisfaction. Phoenix Health Systems. http://www.phoenixhealth.com/icd-10/impacts-icd-10-patient-satisfaction/

Share article on social media or email:

View article via:

Pdf Print

Contact Author

Karla Jo Helms
JoTo PR
+1 888-202-4614 Ext: 802
Email >