Evolving code sets in varied coding systems (ICD-10-CM/PCS, CPT-4, HCPCS Level II, etc.) are creating an intricate, but beneficial platform for the patient care, clinical documentation, data transfer, research, practice analysis and also repayment. Despite this pragmatism, quite a lot of physicians don’t recognize the significance of coding in clinical practice and its impact on reimbursement.
The Tactics to Beat Around the Bush :
Beyond a shadow of a doubt, coding is the backbone of the practice business. Improper medical coding cause claim denialsand culminate ultimately in revenue loss. Thus, it is imperative to address the hardships in medical coding with a fresh pair of eyes.
1. Update to Upsurge : Once the new codes are released, every practice must update their encounter forms, super bills, user guidelines and EHR/PMS systems with the fresh codes to create clean claims and to zero down the denials.
2. Revise to Revive : During every ‘updated codes’ release, revise the corresponding fee schedule up-to-date, so as to improve your bottom line and to achieve compliance.
3. Educate to Excel : Apart from updating the tools and systems, it is indispensable to educate the physician and the coders with the fresh and revised codes and the records desirable to make the codes evident.
4. Check to Cheer: Although, the claim scrubbers effectively validate claims – by recognizing billing errors and creating edits to scrutinize denial issues – a manual check could ensure submission of clean claims. For example, the scrubbers may fail to validate the modifiers even though the software flags the claim as “modifier inappropriate”.
5. Review to Revamp : It is essential to review the new payment policies and coding guidelines constantly, to get acquainted with the payer’s regulations.
A. CPT® : The American Medical Association’s (AMA’s) revised CPT® codes can be effortlessly recognized. The green text in the CPT® code book highlights the modifications that are new to the revised book. Sometimes, the guidelines will modify or add supplementary information for proper codes although the codes remain unchanged.
B. NCD/LCD : Medicare’s National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs) can be reviewed through the Centers for Medicare and Medicaid Services’ (CMS’) website. More to the point, the revised payment policies of private insurance companies can be reviewed through the payer’s website. Reviewing the policies in this fashion aids the coders to – elucidate code use – spot the diagnoses that call for medical necessity – offer documentation requirements.
C. NCCI : The National Correct Coding Initiative (NCCI) Policy Manual for Medicare Services can be reviewed to understand the bundling of codes. Supplementations and revisions to the policy manual have been italicized in red font in the electronic copy.
6. Designate to Delight : It is unfair that most physicians don’t designate the primary diagnosis among an array of multiple diagnoses performed on the same patient. Furthermore, the physicians must number the diagnoses in the order of their significance so as to evade the denials based on ‘medical necessity’.
7. Invent to Infer : Following the aforesaid steps will assist you thwart claim denials associated with code revisions but will not eradicate them utterly, making “denial resolution” obligatory. All the perfectly created codes would not get you the repayment. For instance, one of the new complex chronic care coordination (CCCC) code – 99488 is not reimbursed by Medicare as per its policy guidelines and thus it will be denied. But, on another edge, a secondary or other insurance payer may reimburse for this code. Thus, you need to invent a procedure so as to deduce the non-covered codes for every payer in your network.
To know more about the coding tactics or to clinch a deal !
Contact MedicalBillingStar @ 1-877-272-1572
