Here’s the hard truth: If your organization isn’t leveraging rich, clinically-intuitive, always-current clinical terminology, it’s almost certainly losing revenue. Clinical terminology serves as the bridge between a clinician’s language and the standardized codes required for billing and reporting. So when those terms aren’t precise, comprehensive, easy-to-use, and expertly maintained, the likelihood of denied claims, delayed reimbursements, and messy workflows increases.
Organizations that partner with IMO Health benefit from curated and continuously updated clinical terminology, refined over 30 years, and used by 89% of US physicians, nurses, and PAs. And those who don’t quickly learn the administrative and financial implications.
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Precision Pays: Why clinical terminology is the key to maximizing reimbursement
Keep reading to see exactly how our clinical terminology helps organizations like yours protect revenue and streamline operations.
Reduce denials and recover lost revenue
Higher denial rates mean higher revenue loss, it’s as simple as that. Improve claim accuracy and completeness at the point of care with precise terminology and coding.
With improved primary diagnosis coding and specificity, IMO Health helped The MetroHealth System achieve a 67% reduction in denials – delivering 10x ROI.
Shorten accounts receivable timelines
Ensure shorter AR timelines by accelerating clean claims submissions through precise coding and complete documentation.
One IMO Health client found that a clean claim with no diagnosis errors spent as few as 27 days in AR. However, a claim with a diagnosis error that required rework delayed processing by more than 250 days.
Boost RAF scores with precise coding
Capturing the right codes with clinical specificity ensures accurate risk adjustment factor (RAF) scoring, leading to more complete reimbursement and improved financial performance.
Within six months of implementing IMO Core, Concord Hospital’s cumulative RAF score exceeded the previous year’s by 6.9%.
Lower administrative costs and rework
Coding guidance delivered in-workflow helps organizations identify problematic diagnoses, triggering messages that prompt clinicians to correct codes. This means fewer interruptions for physicians down the road and prevents costly rework.
One organization saved 2,175 hours of coding with IMO Health through improved primary diagnosis coding and specificity.
Eliminate reliance on unspecified codes
Easily capture the highly specific codes required to optimize reimbursement.
Three months after implementation, one IMO Health client saw a 14% reduction in unspecified codes and a 56% reduction in denied charges.
Streamline payer documentation requests
When documentation isn’t specific enough, payers request corrections, which delays reimbursement. IMO Health helps preempt these requests (and slowdowns) by improving the quality of documentation where it starts – at the point of care.
A month after implementation, one client had providers review undocumented HCCs for 71% of affected patients, leading to 41% acceptance and $140K in MA bonuses.
Simplify workflows and save clicks
IMO Health makes documentation easy and saves unnecessary clicks by delivering millions of clinical terms accurately mapped to the appropriate standardized codes.
IMO Health experts manage around 275,000 changes across our platform annually, plus another 20,000 mapping changes across ICD, SNOMED®, LOINC®, and CPT® code sets alone.
