Automating medical coding presents significant challenges due to the intricate nature of health information management, particularly medical records, which form the bedrock of healthcare coding and billing. Protected Health Information (PHI) exists in various formats, including handwritten notes, patient intake forms, and dictated lab reports. This lack of standardization poses a considerable hurdle for AI systems.

Revenue Cycle Management (RCM) professionals—such as coders, billers, and auditors—possess the contextual understanding necessary to interpret and extract crucial information from diverse and sometimes illegible records. The complexity of abstracting documentation is further compounded by ambiguous acronyms, localized jargon, and specialized medical language. Additionally, a substantial portion of the information provided to coders is subjective, demanding a level of interpretation that current AI technology may not yet possess.

For AI to acquire these essential skills, medical coders will need to train the systems, and auditors will be responsible for verifying their accuracy. This technological shift is inevitable, so RCM professionals should consider developing these skills to remain competitive in the evolving IT landscape.

Join us as host Terry Fletcher welcomes Sirisha Bommireddipalli to the show for an insightful discussion on this important topic.

In this episode of the Edge Podcast, Terry and her guest, NSCHBC member and consultant Joe Lessard, discuss how to advise clients on critical business decisions for medical and dental practices. They cover topics such as:

• Insurance acceptance: What insurance plans should practices accept?
• Hiring strategies: When is the right time to hire new associates or partners?
• Location expansion: Should new locations be opened, and if so, where?
• Operational scaling: When should practices expand or contract outsourced operations?
• Equipment acquisition: Should practices lease or purchase new equipment?

Tune in for expert insights on practice management, financial planning for healthcare practices, and growth strategies for medical and dental clinics.

In the context of medical and/or dental insurance, ADR refers to Additional Documentation Request. This is a request from an insurance payer (like Medicare) for additional records to support a claim. It's not a sign of wrongdoing, but rather a way to ensure compliance with policies and verify the validity of claims.

Ignoring these requests, or failure to meet their deadlines, can result in a loss of revenue and trigger additional payers' audits and ADR’s.

Terry outlines the ADRs and best practices to make sure your staff is on top of these requests, which helps save your revenue.

In-house billing offers enhanced internal control and potential return on investment but entails higher costs and staffing challenges.

Conversely, outsourcing is cost-effective, transparent, and consistent but may result in skewed control of financial operations and introduce hidden costs.

Terry discusses this important topic with healthcare consultant Donna White, covering the best option for different-sized practices.

On this edition of the Edge Podcast, Terry welcomes Healthcare Compliance Consultant, Stephanie Allard. The hosts discuss objectives when hiring an external consultant, such as budgets, objectives, outcomes, expectations, and more.

Tune into this important and informative episode to make sure you are prepared

Are Dental Billing and Medical Billing the Same Thing?

Terry Fletcher discusses the similarities, differences, and where crossover between dental and medical billing.

Tune in for advice that can assist clients on both sides to be accurate in their coding and billing processes.

This month on the NSCHBC Edge Podcast, Terry welcomes back, NSCHBC member, Merikay Hunt CHBC, to discuss the pros and cons of a remote versus in-person versus hybrid workforce.

When comparing corporate and healthcare sectors, remote work generally tends to be a better option for corporate roles due to the nature of many corporate jobs being more easily adaptable to digital platforms. However, healthcare often requires in-person patient interaction, making remote work less feasible in most cases.

The best choice depends on the specific role and individual needs within each sector.

On today’s NSCHBC Edge Podcast, Terry speaks with healthcare attorney and fellow NSCHBC member, Ericka Adler, to identify suspected theft in a medical practice.

Terry and Ericka discuss how to identify and prevent theft, plus educate your staff and providers so you are aware of potential red flags.

Some areas to focus on include cash handling, prescription drug inventory, and billing practices. The hosts also talk about what to do if you find suspicious activity, how you can further investigate with the use of proper documentation, and the potential involvement of external auditors or legal counsel.