3 Reasons Why You Need a Software Tool in your HCC Coding Workflow

A medical billing system is only as strong as its coding system, but as the number of medicare advantage enrollees rises, so does the complexity of claims and code modifications. Many new codes, code modifications, and inactive code changes are introduced each year, making the medical billing process arduous and onerous for even the most experienced coders. Claims that are denied or rejected because of coding errors might extend your days in A/R, making it more difficult to recover the entire amount you are entitled to.

Every year, healthcare providers lose millions of dollars due to HCC coding errors, which can lead to regulatory penalties. A proven, automated system can be used by healthcare providers in order to improve risk scores and income while reducing the burden on clinicians. Automated coding support reduces the burden on doctors by integrating the EHR and revealing any coding gaps that may exist and continuously improving the accuracy and optimization of coding across distinct and differentiated network contracts using machine-learning algorithms. Members are prioritised based on the possibility of risk-adjustment improvement.

RAF scores are used by Medicare Advantage plans to predict patient care costs. Higher RAF scores result in increased compensation for physicians. Automation tools can be used to ensure that clinicians are accurately and thoroughly documenting all the information necessary for good RAF scoring. 

Any situations that aren’t properly documented or coded could be flagged by software RAF solutions, which could speed up the scoring process and provide updated notifications. Benefits of integrating an HCC coding software with your EHR include the automatic evaluation of patient records and notifications if a given diagnosis has an HCC code associated with it. As part of the claims process, coders transform EHR-indicated services given by physicians into billable rates for the practice. In today’s medical billing world, having knowledgeable medical billing employees is essential, but having the right software tools at your team’s disposal is even more necessary. 

With so much to do, many clinics find that some claims get out incorrectly, resulting in claim denials and additional work to recover the cash. After the first submission, a large number of claims are rejected (as many as 5 percent , according to industry reports from the American Medical Association). In other cases, as much as half of those claims are never resubmitted since personnel are focused on processing new claims, and detecting the errors would involve a lot of manual effort and time they don’t have. These refused claims can be avoided if minor mistakes are eliminated.

It may be challenging to keep up with the changing volume of coding if HCC coding is limited to a small in-house staff. To handle medical coding manually requires a significant amount of time, money, and effort. This is especially true as the number of clients grows and the need for efficiency and reduced workload grows. Because of the numerous benefits it provides, utilizing HCC coding risk adjustment software becomes necessary.

The HCC Coding software and workflow depends on the needs of each company, the size of the organization, as well as other logistic and financial factors.

It’s not unusual for the medical community to announce new codes each year while revising or removing older ones. The key to increasing income and collections in every medical specialty is submitting clean and correct claims. Manual codebook lookups and printed codebooks can no longer keep up with the ever-increasing number of CPT, HCPCS, and ICD-10 codes, which are updated hundreds of times a year.

It is possible to create more efficient coding processes by using software that integrates knowledge from all of the most popular coding and reference books into a single repository.

Medical coders are expected to stay on top of changes in coding standards, rules, and guidelines. Certifications and continuous education standards must also be kept up to date. They can also benefit by following government and healthcare organizations’ websites, blogs, email lists, webinars, seminars, and other online tools for the latest information.

Certifications and updates necessitate an enormous amount of time and effort. Medical coding undergoes significant shifts from time to time as a result of major updates. Many new codes were introduced with the introduction of ICD-10, for example. There are approximately 19 times more procedure codes in ICD-10-PCS than in ICD-9-CM volume 3, while there are approximately five times more diagnostic codes in ICD-10-CM.

Occasionally, the volume of coding that needs to be done may surpass the capabilities of in-house staff, especially if done manually. This might lead to coding backlogs and payment delays. With the use of coding software, a stable number of medical coders may considerably minimize this strain, increasing efficiency and productivity in the process.

Some of the 3 key reasons why you need to include an HCC Coding Software in your workflow are:

1. Cost-Effectiveness

The cost of hiring medical coders is high. There is a shortage of medical coders at the moment. As a result of the ICD-10, coders had to master the new system. Due to ICD 10’s deployment, many medical coders will be forced to retire as their average age reaches 54 in the near future.

It is far more difficult to find qualified coders for specialty-specific coding. Depending on where you live, you may not be able to find medical coders that meet your demands. Even though qualified medical coders are scarce, their earnings are rising because of it. Programmers today have a plethora of professional paths to choose from, making it tough to keep them around. According to the AAPC, the average annual salary for a medical coder is $52,411. A higher salary is expected of certified coders and those with extensive experience. Outpatient documentation experts and physician practice managers make an average annual salary of $64,000 as certified coding specialists.

As a result of erroneous procedures and/or code faults, there could be additional fines and regulatory fees.

Thus, the necessity for a ‘low cost, high benefit, and high reward’ system must be implemented in order to improve this process. With a small number of medical coders and efficient overall management, coding software could be used more effectively.

Every insurance company has its own set of coding guidelines that must be followed to ensure “clean claims,” and when these guidelines change, the likelihood of a claim being rejected increases. Rejected claims cause your revenue cycle to slow down and your team to spend more time submitting claims, all of which has a negative impact on your cash flow. It is difficult or impossible for most medical practices to devote additional resources to increasing the percentage of billed charges that are collected. The money you should have received for services you supplied could be lost if a claim is denied because of a small error in the paperwork.

Your revenue cycle might be severely impacted by mistakes. Ideally, your team can immediately detect an error in a rejected claim and resubmit it, recouping most or all of the revenue. As a result, you may have to write off the claim as bad debt because your staff either doesn’t have time or doesn’t know what the problem is.

Before a claim is sent out, it can be automatically checked using the software. Claim data is compared to the most recent industry standards (such as LCD and NCD modifications), small inaccuracies in patient data or codes are checked, and the claim is subject to payer-specific guidelines.

2. Improved Quality & Accuracy

With automated ICD-10 coding, both the present visit and pertinent clinical history of a patient can be taken into account for more precise coding. At the point of care, codes are correctly detected and inputed, resulting in prompt and accurate compensation. Providers and employees save time and money by not having to go back and fix errors that were made in the first place.

Also, At the point of care, the use of technology enables providers to identify the relevant codes for a patient’s visit. As a result, physicians don’t have to interrupt the care process or wait until the end of a long day to finish coding and close the charts. As soon as the visit is ended, providers are certain that all paperwork and coding is completed.

3. Scalable & Seamless Work Process

Medical coders must keep up with the current standards and coding clinics as they are revised. When assigning codes, the suggested auto-coding method will take the most recent coding clinics and guidelines into account, making it easier to stay in compliance.

The extent to which auto coding improves documentation is another key part of compliance. Medical records will be able to identify any missing information thanks to this method. Errors or anomalies can be instantly flagged, tracked, and reminders sent to physicians so that they can fix the gaps. It can also have a substantial impact on the improvement of clinical documentation (CDI). Complications and comorbidities will be better documented if the solution identifies potential holes in the overall CDI process.

AI-assisted auto-coding will cut down on the amount of time coders need to spend reviewing medical records, extracting diagnoses and procedures performed, and then producing accurate findings.

There will be an increased focus on a machine-first delivery paradigm, and coders will be able to manage flagged or complex coding in both inpatient and outpatient settings with more proficiency when the confidence score of auto-coding solutions increases Coders’ abilities and performance will be enhanced as a result of this. Increased facility revenues, lower denial rates, and less reliance on coders are all benefits of accurate and precise coding.



The revenue cycle management process begins with patient scheduling and ends with billing and payment collection. There are numerous phases along the way that can have a negative impact on your ability to code correctly and maximize revenue. Having a fully integrated set of software solutions that effortlessly transfer data at each phase is essential for streamlining your revenue cycle management. An integrated system avoids the need for manual data transmission, eliminates costly errors, and speeds up the process from the patient’s first visit to the collecting of their medical records.