As digitisation marks a new chapter for FQHC healthcare, providers are considering the role of AI in enhancing coding accuracy for FQHC. Medical coding has gone through a massive evolution in the wake of expanding healthcare services. Healthcare facilities, including FQHCs and hospitals, have integrated data analytics to make medical decision-making more data-driven. Hence, medical coding for every piece of documentation entered into the healthcare system with accurate assignments and billing requirements is crucial for FQHCs today.
Importance of FQHC medical coding accuracy
Medical Coding in FQHC involves the translation of diagnoses, procedures, and treatments into accurate alphanumeric codes. Following the guidelines of the ICD-10 coding system, medical coders maintain the legitimacy of efficient documentation for FQHC billing services.
The need for maintaining FQHC medical coding accuracy goes without saying. FQHCs are funded by multiple sources like Medicare and Medicaid as licensed under the guidelines set up by the Health Resources and Services Administration or HRSA. Hence, the procedure of patient records, treatments and other relevant clinical notes in FQHCs adheres to a very unique model of billing documentation.
How is ICD-10 coding for FQHC significantly different from normal medical coding?
FQHC medical coding is driven by more specificity-driven documentation that differs from typical outpatient or hospital clinic coding. This makes the coding guidelines vastly different and more complex than traditional medical coding.
The following medical codes are unique to patient encounters in a US-based FQHC:
- G0466 – new patient.
- G0467 – established patient
- G0468 – initial preventive physical exam (IPPE) or an annual wellness visit (AWV).
- G0469 – mental health, new patient
- G0470 – established patient, mental health
There are also unique HCPCS medical revenue and billing codes specific to FQHC services. This proves the increasing complexity of FQHC medical coding, demanding more accuracy and efficiency in the FQHC workplace.
Problems Faced in Maintaining: FQHC Medical Coding Accuracy
Reimbursement delays are extremely common in the healthcare industry. However, in FQHCs, matters are more serious than facing a mere claims denial. FQHC is run by a dual-billing structure that involves federal grants and cost-based reimbursements for Medicaid patients. With multiple fee structures and reimbursement rates to account for, a single reimbursement delay could severely affect their collection rates and jeopardise the entire FQHC revenue cycle.
Hence all the billing claims submitted by an FQHC must adhere to every single point of documentation, including modifiers in medical code. For this, providers must account for the necessary factors that might affect medical coding, including:-
- amount of time spent with the patient for Advanced Care Planning (ACP), necessitates using unique CPT codes
- amount of time spent counselling by mental health professionals
- Accounting for whether two billable encounters were completed on the same day
Maintaining FQHC Medical coding accuracy: Disadvantages to Providers
- The accounting of every guideline results in massive administrative burnout for physicians. They not only have to care for their patients but have to continuously keep in line with the latest regulatory changes, industry trends, as well as updates to coding systems.
- Physicians must also adhere to every medical coding guideline, failure to which will not only jeopardise the entire FQHC billing process but lessen the provider’s compensation for the care they have given to their patients.
- Instead of caring for patients, physicians spend most of their time accounting for which specific guidelines to be followed for documentation, and where to administer what medical codes. They fail to communicate with their patients, losing out on patient satisfaction and the purpose of FQHC altogether.
- Services without a proper face-to-face encounter with the patient for a certain amount of time are legally not billable. With the mounting pressure of administrative burden, guideline adherence and lack of patient satisfaction, if physicians are not billed for their services, the overall provider health will decline, making providers no longer willing to contribute to FQHCs.
You can also read this blog about How AI Medical Scribes Improve FQHC RCM.
AI in enhancing Medical coding accuracy for FQHCs
Providers sign up to serve the community with proper care, not account for administrative guidelines and keep typing on a computer. Hence, AI in enhancing medical coding accuracy for FQHCs is more than necessary to streamline documentation and revenue cycle management.
Implementing AI in healthcare has already made significant strides in delivering patient care efficiently.
Prismetric forecast the future of the healthcare AI market is to reach a whopping US $188 billion by 2030. With the US’s one-fifth of hospitals and medical organizations already integrating AI-driven solutions into their workflow, FQHCs must take advantage of this advancement to secure their place in efficient patient care in today’s US healthcare.
AI-powered FQHC documentation – different ways and means
Healthcare centres including hospitals and clinics have integrated AI software into their administration management in various ways and means. With inadequate staff and limited budgets allocated to FQHC’s funding, providers use automated solutions to deal with the overwhelming work pressure.
How Hospitals are implementing AI for their administrative processes:-
- AI-powered medical scribes for FQHC RCM: Medical coding for revenue cycle management has one of the most complex documentation procedures, which is entirely automated with the help of AI in enhancing coding accuracy for FQHCs. FQHC revenue cycle management (RCM) improve the reliability of reimbursement by tackling the fundamental challenges of FQHC revenue cycle management, which are caused by high patient volumes, intricate billing processes, and the requirement for thorough documentation.
- AI medical coding: With the help of advanced machine learning algorithms, AI-medical coding software enables real-time visibility in diagnosis and treatment medical coding. An FQHC provider gets medical code delivered in minutes with accurate clinical notes including charts with thorough code analysis that promises increased FQHC patient throughput and quality.
- AI medical billing: With sophisticated reporting offered on your dashboard for financial and organisational KPIs, AI medical billing and RCM software make clinical notes EHR-ready while reducing the risk of overbilling or underbilling. This opens the door to less needless claim denials and promotes a smooth medical billing procedure.
- AI voice assistant: With AI voice assistance, any complex documentation can be easily managed. Clinical notes are generated automatically while a patient and physician are interacting during patient appointments.
Providers are in dire need of every help out there when running an FQHC. Even though there are multiple options available in today’s AI market, choosing the right software becomes very overwhelming for providers, especially when dealing with buzzwords like AI and machine learning crowding their use cases.
Each service caters to an FQHC provider’s demands and needs, but they are all separate devices delivering niche services. Hence, finding an all-in-one solution is extremely hard…until RevMaxx comes into the picture.
An All-In-One AI Medical Coding Assistant
Physicians require an AI assistant that specifically adheres to FQHC guidelines while delivering holistic solutions. RevMaxx understands these special needs and delivers accurate clinical notes, but trains its machine learning algorithm per strict FQHC reporting guidelines, billing requirements, and medical coding documentation, thereby going beyond traditional AI medical coding software.
RevMaxx’s special abilities stem from its accurate report templates that align with not just insurance companies but also the HRSA, the main funder for FQHCs.So, it ensures the generation of accurate medical codes through a three-step function during every patient appointment:
- Record: FQHC Providers press “record” and start interacting with their patient. RevMaxx listens and transcribes entire natural conversations into organised notes.
- Code: RevMaxx converts the patient’s diagnosis and the provider’s treatment plans one by one into designated medical codes for efficient documentation
- Review and Send: Providers review the entire FQHC-customised note and send it to EHR for the billing process
This entire process is accelerated with RevMxx’s custom features for FQHC billing. The primary features include:-
- AI in enhancing coding accuracy in FQHC Automated
RevMaxx’s technology leverages cutting-edge NLP solutions to vehemently improve coding quality in FQHC documentation and promise productivity and accuracy throughout the entire audit process
- Seamless Deployment for Uninterrupted Coding
RevMaxx’s deployment team promises speed and continuity for a smooth transition into the AI-powered FQHC documentation process, making it a point that your FQHCs can quickly implement AI medical coding without disrupting their operations.
- One-click Review and Verification of Medical Code
After RevMaxx generates medical code and patient-doctor interaction organised into EHR-ready charts, doctors can review and verify them according to the diagnosis and treatment plans suggested, making clinical notes ready to be sent to EHR without any further hassles.
- Collaborative AI-powered Coding Solutions
Provides an all-in-one documentation platform to smoothen collaboration between medical coding, provider care, billing process, and CDI teams within the system.
When considering automation, FQHCs face the challenge of choosing the software that not only meets their documentation needs but must accommodate the specific rules of FQHC billing. RevMaxx takes care of that. Our team understands the possible legislative barriers that could cause complications in caregiving for FQHC, and power a medical scribe that adheres to every necessary federal requirement. With legislative barriers out of the way, RevMaxx promises its providers with accurate medical code that:
- Rejunivates efficient RCM process
- Guarantees 100% reimbursement for provider services
- Passes all FQHC audit trails
- Secures trust among disadvantaged patients
- Brings back joy of community service and care to providers
Conclusion
For FQHC providers like you, patients are your priority. We uphold your priority by introducing AI to enhance medical coding accuracy for FQHCs. With solutions like RevMaxx AI Medical scribe, providers gain the advantage of having a 24/7-accessible AI assistant that takes care of rising tides of documentation and lets them do what they do best; serving care to the underprivileged of our society. RevMaxx is here, with its medical and technical expertise team to help FQHC providers recover millions of dollars of unpaid reimbursement claims. Mixing software with artificial intelligence, AI in enhancing coding accuracy delivers a holistic approach that fits every FQHC goal and budget and lets providers continue providing quality camedical re for our communities.
