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The Smart Rev Cycle Blog

Medical Coding Best Practices: Exception-Only Coding

Medical coding software is an important tool, but without the right processes in place, technology is useless. Technology can only be powerful when it is backed by users who follow industry best practices. One of the most important best practices in medical coding is coding by exception-only. Despite this, most coders continue to practice the old way of manually reviewing every single encounter. 

Defining Exception-Only Coding

Exception-only coding is a method of coding where coders only stop to review encounters with errors. They do not touch every single encounter. Rather than looking at every single encounter to find missed charges or errors, the coder waits for their rules-engine to flag them on an encounter that needs to be reviewed. This method leverages the power of technology to save time in FTEs and improve the accuracy and consistency of coders across the board.

Exception-Only ROI

To explain the importance of exception-only coding, we will give an example. Let’s think about a practice that handles 1000 encounters per day. The average coder who manually reviews every single encounter can process 25 encounters per hour. Let’s say that coder finds 2 missed charges, $25 each, that the software would not have caught. They saved the practice $50. It took them 40 hours to process all 1000 encounters, and with an $18 an hour salary, it cost the practice $720.

Practice B uses exception-only coding, and they rely on the technology to flag them on encounters with errors. With this practice in place, they can process 141 encounters per hour. They complete all 1000 encounters in 7 and a half hours, and it only cost the practice $135 – vs. the previous practice who spent $720. They missed the $50 in missed charges, but next time they will build a rule to capture those charges. 

Was it worth it for the coders at the first practice to review every single encounter manually? Absolutely not! The second practice saved $535 per day by using exception-only. The charges that the technology did not catch were not significant enough to compare with the time savings they experienced.

Challenges to Exception-Only Coding

For coders, switching to exception-only coding can be very difficult. It’s a complete mindset shift. In the past, it was their responsibility to search through every encounter to find errors or missed charges. The sense of reward came from finding the needle in the haystack. It is hard to tell coders that what they used to find rewarding in their job is no longer necessary, and in fact, it costs the practice time and money. 

There is a new sense of reward that can be found. It’s not in catching mistakes – they need to learn to rely on technology for that. Instead, they can be on the lookout for new rules to build. When they catch things that the rules engine is not catching, they can build a new rule to make sure they don’t miss any charges or make any denial-causing mistakes.

Using Analytics to Reinforce Exception-Only Coding

Another way to reinforce this process change for coders is to regularly monitor productivity through revenue cycle analytics. This not only allows you to see whether or not your coders are touching every single encounter, but it also allows you to monitor their productivity. You can set measurable goals for productivity improvements. Coders can find a new sense of reward by achieving a high number of encounters per hour.

White Plume loves to partner with clients to produce world-class revenue cycle outcomes. Our powerful rules-engine AccelaSMART allows coders who are coding on an exception-only basis to be 3x more productive than their peers. Find out more about our products and the ROI they could provide for you.