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Do a google search on the term “Healthcare Programmer” and “Health Data Scientist” you will get some interesting responses. Some related to IT or IS systems, Some requiring Medical Coding knowledge. Usually or very rarely any information of how these two can intersect. If you are like myself continuing my journey into healthcare data has proven to be challenging.

The process of health data mining is known as Medical Coding or Abstracting. This is usually performed by individuals being assigned a specialty like Inpatient or Cardiology and assigning ICD 10 CM/PCS and/or CPT/HCPCS Classifications to interpret the patient medical record into a series of numbers computers can understand. Abstracting the medical record is necessary in healthcare today because of the Centers for Medicare and Medicaid services require it of hospitals and physician practices to demonstrate compliance. As of current, it is largely manual in nature. . Although EHR vendors tout to have made the process electronic, it usually requires APIs to work efficiently. If you are transitioning into this industry, be prepared for this. Especially if you plan on being employed in any Machine Learning or Automation process. All aspects of this field require some sort of clinical knowledge.

Most health data analytics roles want staff who know SQL or Access or another RDMS system. They also want to know you can Visualize the data into meaningful information using Tableau. This is especially valuable today because so many hospitals need this information to recover lost finances and claim Denials are an easy trend to measure. Some of these trends do require some clinical experience like a Nurse Informatics role or a Nurse Auditing role. You might be able to negotiate if you have a clinical documentation certification (CCDS or CDIP).

As health information technology continue to challenge the scope of practice, continue to evaluate and ask where the next 10 years will take you. Any technological advancement requires consistent change and commitment to growth. Take that as a challenge and come along for the ride and show those recruiters what you can do!

Helpful tips and tricks to reduce denials

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I did my first virtual webinar this week with my local AAPC chapter on a non-traditional medical coding topic. Although I have my medical coding certification, I have been working in Medical billing and appeals over the past 5 years. I really enjoy the troubleshooting aspect of it. Stuff gets submitted to the payer broken, error message ensues, then you try and “fix” it. This has been my new norm for the past 4+ years. I did it on the physician side for 2 years, now I am doing it on the hospital side…and even with the current state of healthcare, there are no signs of this process stopping any time soon. Although medical coding is prior to the health insurance claim being submitted to the insurance company, the point I made in my presentation was that it is helpful to have medical coders in different aspects of the healthcare business cycle. Think about it, Medical Coding professionals have to understand how and why codes are assigned to the claim for billing. With this information, your medical coding professionals, especially newer students, and might be able to help getting those “error messages” overturned. This can result in reimbursement for services for the facility or healthcare providers practice.

Why Denials continue to be a problem?

You can think of an insurance denial as an “error message” preventing payment to your providers office or healthcare facility. Knowing and understanding how to resolve a denial requires a deep understanding of medical coding and the codes that insurance companies use to communicate denied claims. These are often known as Reason and Remark codes and can be found here.

Your Medicare Administrative Contractors can be huge resources in this process. They often have free webinars that can provide you invaluable information on medicare guidelines for reimbursement, along with common denials that occur within their jurisdiction that might help in understanding claim resolution processes. The more you see and understand different types of denials you encounter, the more comfortable you will become with the process needed to obtain appropriate reimbursement for the services provided by your facility or physician.

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