The RCxRules Blog

Medical Coding Software: 3 Things to Look for When Choosing a Vendor

Medical coding software that improves reimbursement, compliance, and productivity is a priority for many medical groups. A recent survey of the Healthcare Financial Management Association (HFMA) showed that 43% of healthcare leaders are focusing on automating Revenue Cycle Management (RCM) functions to reduce cost. There are several types of medical coding software that can help achieve this, each of which focus on a specific segment of the market (i.e., facility vs. professional).

When looking for a vendor, you’ll first need to determine whether your group needs administrative or clinical coding software. In this article, we’ll focus primarily on technology that assists with administrative coding rather than clinical coding.

What’s the difference between clinical and administrative coding technology?

As defined by the AAPC, clinical coding is the transformation of healthcare diagnoses, procedures, medical services, and equipment into universal medical alphanumeric codes. Software types commonly used in a clinical coding context includes Computer Assisted Coding (CAC) and Natural Language Processing (NLP), which are technologies used to scan a provider’s clinical note and recommend diagnosis codes based on what was documented.

Administrative coding focuses on the administrative accuracy of claims, or in other words, ensures claims meet a payer’s specific requirements. One of the most common and widely used types of administrative medical coding software is a claim scrubber. Claim scrubbers help ensure the correct ICD-10 and CPT codes are included on a claim, among other administrative payer requirements.

There are three important things you should look for when choosing a medical coding software vendor for administrative coding:


1. Customization

Every medical group has unique needs and payers with different requirements. These requirements are always evolving, so your group needs to be able to customize your medical coding software to allow for flexibility. Often, customization comes at a cost. That cost may come in the form of the headache that results from having to reach out to a vendor every time you need to make a minor change, or it may be the actual monetary cost of paying a service member to customize functionality for you.

Consider choosing a medical coding software that allows you to create infinite custom rules yourself, so you can proactively identify and address your most common coding and billing errors. An out-of-the-box solution is not going to provide custom rules specific to your individual payers.

2. Automation

Automation allows you to enable an exception-based workflow and review 100% of claims for accuracy, which is key to successful revenue cycle management. By leveraging automation, you circumvent the need to have an army of coders at your disposal to make sure every charge is reviewed manually. Automation helps your team do more with less and focus on your most important initiatives.


By pointing out coding and billing discrepancies for coders to further review, medical coding software can reduce time spent “hunting” for errors. Consider medical coding software that can automatically correct common coding and billing errors, thereby decreasing your team’s administrative burden even further. Automation paired with customization allows your team to scale your Revenue Cycle Management processes by enabling them to handle increased claim volumes without needing to hire additional coding and billing staff.

3. Security

It’s vital to ensure the medical coding software you work with protects your healthcare information. Partner with a vendor that has defined security protocols. One of the highest and most comprehensive security measures to look for in a vendor is HITRUST certification.

In short, when purchasing medical coding software to help you get clean, payment-ready claims out the door, you first want to decide what type of software is right for your organization—administrative or clinical. Once you’ve determined that, it’s important to vet the solution to make sure it will complement your growth and productivity goals while protecting your information.

Learn how our Revenue Cycle Rules Software can help you. Set up a meeting today.



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