InsightsWhy a pilot tells you more than a proposal
By the PRISCO MedCode Solutions editorial desk
A proposal describes what a vendor intends to do. A pilot shows what the vendor actually does with your charts, your payers and your documentation habits.
When we begin a pilot we agree the scope with you, sign a Business Associate Agreement, and work a representative sample from the specialties that matter most to you. Two things are studied side by side: accuracy and productivity.
Accuracy
Every code is compared with what the record supports, and each variance is classified by type and severity. A missed diagnosis is not the same as an unsupported modifier, and the pattern across many charts matters more than any single error.
Productivity
We look at turnaround and throughput by specialty and chart complexity, and at how quickly a team recovers after a query or an escalation.
Reading the two together
A team that is fast but inaccurate creates denials and rework. A team that is accurate but slow creates backlog. The pilot shows where the balance sits today and what it would take to improve both.
The report is yours to keep, whether or not we work together.
That is the purpose of a pilot: a decision made on evidence rather than on promises.
InsightsThe quiet cost of a denied claim
By the PRISCO MedCode Solutions editorial desk
When a claim is denied, the unpaid amount is only the visible cost. Behind it sits investigation time, appeal paperwork, a delayed payment and, often, a patient who is confused about what they owe.
Most denials have a home
Nearly every denial traces back to a stage of the revenue cycle where something could have been caught earlier. The usual places to look are:
- Registration and eligibility details that did not match the payer’s records
- Authorization that was missing or did not cover the service
- Coding and documentation that did not support each other
- Medical necessity that was not made clear in the note
- Filing deadlines that quietly passed
Prevention is a loop, not a project
Appeals recover revenue, but prevention keeps it. We classify each denial by root cause, assign an owner, send the lesson back to the team that can change it, and check later that it worked.
An appeal wins one claim. A fixed root cause protects the next hundred.
Done consistently, the denial report stops being a list of problems and becomes a map of where the process can improve.
Coding updatesReading the calendar of coding changes
By the PRISCO MedCode Solutions editorial desk
Medical coding is a moving target, and the movement follows a predictable calendar.
- ICD-10-CM updates take effect each year on October 1.
- CPT updates take effect each year on January 1.
- HCPCS Level II codes are updated through the year, with quarterly releases.
- NCCI edits are refreshed quarterly.
What a good team does before the date
Before each effective date we brief coders and auditors on new, revised and deleted codes, update checklists and audit tools, and point out the specialties most affected. After the date, the first audit samples look specifically at the changed codes.
Always verify at the source
Summaries like this one are a starting point. Official code books, licensed encoders and the CMS and payer publications remain the source of truth, and every code in our work is verified against them.
BlogAccuracy and productivity are not rivals
By the PRISCO MedCode Solutions editorial desk
Teams often treat accuracy and productivity as opposites, as if every gain in one must be paid for in the other. In practice, they are two readings of the same process.
Why they belong together
A coder who moves quickly but misses documentation support creates rework further down the cycle. A coder who is careful but slow leaves charts waiting. Either extreme costs money; it simply appears in a different report.
How we keep both honest
- Measure both on the same sample of work, by specialty and complexity.
- Agree targets in writing, based on your baseline rather than a generic benchmark.
- Share feedback weekly, so a trend is corrected while it is small.
- Re-check after every fix to confirm it held.
Fast and right is a result of method, not of pressure.
ComplianceOffshore coding and PHI: the questions worth asking
By the PRISCO MedCode Solutions editorial desk
Working with a coding partner outside the United States is common, and it is workable when the right safeguards are in place. These are the questions we encourage every provider to ask, of us and of anyone else.
Start with the agreement
A Business Associate Agreement should be signed before any protected health information is handled, including for a sample. HIPAA applies to a Business Associate directly, wherever it is located.
Questions worth asking
- Where does PHI reside, and can the work be done inside our own systems?
- Who can access it, and how is that access logged and reviewed?
- What controls apply to devices, printing and removable media?
- How are incidents reported, and how quickly?
- What happens to the data when the engagement ends?
- Do any subcontractors touch PHI, and are they bound by the same terms?
Check your own contracts
Some payer contracts and state programs restrict offshore access to PHI. We review yours with you before work starts.
This article is general information, not legal advice.
InsightsWhat a useful RCM scorecard looks like
By the PRISCO MedCode Solutions editorial desk
A scorecard is only useful if it leads to a decision. Numbers on their own describe the past; a useful scorecard also points to the next action.
Four habits of a good scorecard
- Context. Every metric is shown with its trend and the likely reason it moved.
- Ownership. Each result has a named person who responds to it.
- Separation. Preventable causes are split from those outside the team’s control, so effort goes where it can help.
- Distribution. Averages are paired with aging buckets or sample ranges, because an average can hide the claims that matter most.
Targets from your own baseline
Specialty, payer mix and workflow all change what good looks like. We agree targets with each client from their own baseline and revisit them as the work matures.
A metric without an owner is only an observation.
