Single-path coding is here – but what exactly is it? And how can it benefit your healthcare organization?
For many hospitals and health organizations, single-path coding is an important strategy to enable coding teams to streamline processes, maximize coder output, and reduce costs. By removing the barriers between professional and facility coding and leveraging a single coding platform's benefits, hospitals and health care systems can improve their coding productivity, accuracy, and compliance – using one coder instead of many.
So, let’s explore the many facets and benefits of single-path coding.
The Rise of Single Path Coding
Single-path coding refers to one coding professional's ability to assign both facility and professional service codes to an account, versus using separate specialized coders during the revenue cycle workflow.
As hospitals look to boost operational efficiency, reduce overlaps, and address coding errors, single-path coding can break down silos in the revenue cycle and across inpatient and outpatient services.
While professional fee codes primarily capture the complexity and intensity of physician care or surgery provided during a visit, facility coders code for diagnoses and invasive procedures completed in the hospital.
Typically, the facility coding flows to the UB04 claim form, and the physician fee coding flows to the CMS 1500 claim form. Separate coders have generally done these two types of coding with separate coding backgrounds, training, experience, and certifications. By eliminating the walls between professional and facility coding, implementing a single-path coding solution can cost-effectively maximize an organization’s coding productivity.
Why Move to Single Path Coding?
Many hospital systems are moving to single-path coding to eliminate duplicative processes – i.e., two different coders looking at the same documentation – and to optimize productivity. In addition, costs are reduced when only one coder touches a record and completes both coding types.
Another advantage is that with one coder assigning both Profee and outpatient codes to claims, discrepancies and variances in the codes of each can be eliminated. This will decrease the amount of claims rejections and other billing issues. It will also help meet demands for AHRQ (Agency for Healthcare Research and Quality) and HCC (Hierarchical Condition Category) data elements.
Once implemented, single-path coding helps eliminate potential variances between professional fees and facility charges. It eliminates having two people looking at the same documentation and arriving at different codes. It also helps healthcare facilities ensure they’re capturing all modifiers and edits at the point of coding.
What Are the Challenges?
The main challenge many health organizations face is to have coders that are sufficiently trained in both facility fee and professional fee coding. The coder will need to know the differences when coding the same encounter for both.
Another challenge is having the technology to accommodate single-path coding. Mapping out how the different claims data will flow from coding will take crucial planning. Some systems allow coders to select “Single-Path Coding” for certain specialties. Starting out with a small amount of specialties and then building out as the initial areas are conquered can be an effective way to implement.
Real-World Example: University of New Mexico Hospitals
For the University of New Mexico Hospitals (UNMH), a five-hospital system, and the state's only academic medical center, single-path coding emerged as a solution to an ongoing problem.
Specifically, the organization was using paper billing tickets in its outpatient clinics. These superbills were printed with the five most common diagnoses for each clinic, with a space to write in other diagnoses when necessary. Providers circled or jotted down the proper diagnosis, and the paper ticket was then routed to the appropriate departments for entry into the various systems before being sent for coding. Unfortunately, this paper process did not allow the hospital to meet ICD 10 diagnosis specificity criteria.
The hospital decided to implement a single coding workflow with one coder managing both facility and professional fee coding. This ensured that the coding would include all documents needed for inpatient and outpatient facilities and professional fee coding.
UNMH opted for a staged implementation beginning with diagnoses coding to meet the 2015 ICD-10 mandate. This allowed time to build out system automation to accept CPT codes by both billing systems and work through issues related to workflow changes within the financial system.
Coders underwent hands-on training in the new technology and ensured their proficiency in facility and professional fee coding and all outpatient clinical services. The ensuing dual coding environment enabled coders to be expert users in the new technology, with increased diagnosis coding accuracy.
Single-path coding is an idea whose time has come. But for all its potential, there are some important steps hospitals and healthcare organizations should consider.
- Getting your Processes Ready
Technology adoption can challenge organizations, and the fear of change can be daunting. Start with a thorough assessment of your current processes and identify any necessary organizational and workflow changes. In addition, it’s important to factor in adequate planning time, including thorough vetting of coding, billing, and financial system functionality. Organizations should look at the entire process from registration to revenue capture to existing financial systems. They should also take the time to analyze staffing to ensure optimal productivity.
- Hiring the Right People
One of the biggest challenges for health organizations and hiring managers will be finding coders with the right experience in various areas.
Along with the necessary education and training required to do the job, hiring organizations should look for professionals who possess the following attributes:
- Variety of experience and expertise:Though specialized training is needed for areas such as anesthesia, cardiology, and orthopedics, a variety of expertise can be a valuable asset. Given the shift to single-path coding, organizations should look for coders who are cross-trained on facility and pro-fee coding.
- Independent and resourceful:In today’s fast-paced environment, managers need coders who can independently conduct research in response to questions and difficult coding challenges. If a hospital is performing a new procedure, the coder should be able to research the procedure to gain a clear understanding of how it’s performed and coded.
- Reliable:Value-based reimbursement demands dependable coders who consistently meet and maintain quality and productivity standards. Attention to detail enables coders to identify changes that might impact coding before it becomes a large problem.
- Professional:Coders should be able to communicate and interact in a clear manner. Professional verbal and writing skills are critical to communication that supports accurate coding and documentation.
- Certification:A coding certification should be required for any new hire. It’s important to make the job requirements and certification expectations clear during an interview process. With the move to single-path coding, hiring coders with certifications in facility and pro-fee coding is strongly recommended.
At GHR RevCycle Workforce, we’re 100% focused on placing highly-skilled full-time revenue cycle professionals in various positions, including remote opportunities. To find out more, visit our website today!