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Rest Assured – Coding Howlers in Oncology Practice are Removable

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Oncology is a clinically-focused specialty that is undergoing frequent technological and process updates. It requires a high degree of physician’s skill, experience and the urge to learn to stay tuned with the revisions related to documentation, coding, billing, and revenue cycle management (RCM).

Common Oncology-Specific Coding Errors :

Errors abound. Some of the many are:

  • 1. Coders are not up-to-date with on-going changes in codes and related modifiers.
  • 2. Failure to capture correct levels of CPT (Common Procedural Terminology) codes.
  • 3. Under-coding and over-coding errors.
  • 4. Misusing modifiers, using of wrong modifier and mixing up of modifiers.
  • 5. Coders are not conversant with coding for specialist oncology services such as bone marrow procedures, transplantations, and blood transfusions.
  • 6. Coders round off drug administration times instead of noting the exact time.

What the Experts Have to Say :

According to oncologists, correct coding is the main ingredient for successful practice. The complexity and regular updating of coding system contribute to unintended coding errors. According to the American Society of Clinical Oncology (ASCO), failure to complete the code capture at the time when oncology procedures are provided is common.

Continued usage of codes that have been eliminated by Medicare continues to be the bane of the US oncologists. A survey conducted by two nationally recognized experts in oncology practice management-Roberta Buell from OnPoint Oncology LLC and Patrica Falconer from Health Options, on behalf of the Association of Northern California Oncologists (ANCO), revealed that only 1 out of the 14 surveyed practices had updated their oncologists about the elimination of consultation codes by Medicare.

According to Cynthia Stewart, coding education coordinator president of AAPC, problems arise for coders when physicians fail to document the steps they went through to arrive at a diagnosis. Enos further clarifies that coders need to understand the depth or extent of medical decision making. Medical decision depends on complete documentation to make a “medical necessity linkage” between the procedure performed and the diagnosis code.

Tips to Ensure Correct Coding :

There are umpteen of them – to name a few :

  • 1. Be aware of on-going changes in codes and modifiers.
  • 2. Continually train oncologists and coders on coding mistakes and consequences, along with how to avoid the mistakes.
  • 3. Do not neglect equipment or instrument used : Be conversant with recent codes related to the equipment or instrument (e.g. for radiation oncology) used to provide oncology services.
  • 4. Beware of the tendency to code according to the complexity of the diagnosis, rather than the extent of decision making involved.
  • 5. Be aware of new or established (existing) office visit codes and in-patient visit codes established by Centres for Medicare and Medicaid Services (CMS).
  • 6. Make sure you understand the billing rules and regulations for Medicare and private payers. In fact, with the high cost of new cancer therapies, many oncology practices are now verifying insurance information before every treatment.
  • 7. The American Medical Association’s (AMA) multi-specialty Relative-Value Update Committee (RUC) frequently reviews and updates oncology codes. Keep in sync with these changes.
  • 8. Oncology clinics and hospitals will find the guidebook on billing and coding for oncology-related services offered by American Society of Clinical Oncology (ACCO) very useful.

Escapade from the Oncology Coding Malaise :

Perplexed and unsettled due to plethora of oncological coding errors! Don’t panic. Be assured by adopting a prudent approach by outsourcing or rather “Right Sourcing” your coding worries to MedicalBillingStar,as we :

  • A. Are an established, experienced, and knowledgeable one-shop outsourcing vendor for oncology coding in the US.
  • B. Are conversant with intricacies of oncology coding practices and comply with medical coding systems such as International Classification of Diseases (ICD), Current Procedure Technology (CPT), and Healthcare Common Procedure Coding System (HCPCS).
  • C.Understand your EMR and work with any platform, with security features and options. You are free to select EMR/EHR of your choice and we will cover the involved expenses.

Here’s our presentation on 8 Oncology Coding Tips !

The Hallmark Solutions To Frequent Medical Coding Gaffes

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Most healthcare providers are on the horns of dilemma due to the medical coding mistakes and the ensuing claim denials. The Best Medical Coding Practice paves the Greenway to recoup your dollars for the exact service rendered by you, whilst improper coding takes away your dollars. This article underscores the common coding mistakes and the conduit to resolve them.

Ensure Medical Necessity :

The healthcare insurance payers are progressively more apprehensive about the medical necessity. The payment for the physician services is based on the CPT codes, whereas the claim approval and reimbursement by the payer is based on the diagnostic codes. Thus, elucidating the harmony between CPT and diagnostic codes is a key step in the coding process. If the payer deems that the service is medically necessary, you will be paid or else your repayment will be hampered and/ or even you will be monetarily penalized.

Ethically Exploit the Modifiers :

A Modifier is the Nucleus of Multi-procedure Coding-based medical claim. Modifiers can be the benchmark for full reimbursement – abridged reimbursement – complete denial – or partial denial. Forgetting, abusing or confusing modifiers in requisite circumstances may lead to negative impacts on reimbursements.

Examples :

1. Failure to tag on Modifier 25 to the E&M service or erroneously appending it to the surgical procedure will cause claim denial.
2. A CPT code linked with Modifier 51 notifies the payer that two or more procedures are being done on the same day and to employ the multiple procedure payment formula. Modifier 59 tells that the procedures/services those are not usually reported collectively, but are apt under a specific circumstance.
3. CPT advocates using Modifier 24 with an “unrelated E&M service by the same physician during a postoperative period.”
4. Modifier 53 is tagged on, when the physician opts for ceasing a surgical or diagnostic procedure because of extenuating events or a hazard to the patient’s health.

Shun Missed Charges :

Most biggies among healthcare providers, can simply fail to spot charge captures for the multiple services delivered. Imaging, laboratory and other subsidiary services often miss the unwritten/ verbal orders of the clinic or lab staff. Better avoid or document the ‘verbally communicated orders’ so as to rule out this problem.

Take Cognizance of the Code Revisions :

Many providers use out-of-date encounter forms thinking that updating is an onerous and mind-numbing task. But, it is inevitable to update the Superbills with the revised codes so as to recoup your payment for the rendered service. Every year, procure new CPT, HCPCS and ICD-9 books and educate the pertinent staff members to get accustomed with the revised codes.

Eschew ‘Over-coding’ and ‘Under-coding’ :

Over-coding is sometimes deliberately done to acquire a higher reimbursements, but it may lead to claim denial and often resubmission or appeal processing/ penalty cost more than that of the anticipated payment.
Example: If, the code 413.9 (unspecified angina pectoris) is used along with 414.01 (Coronary atherosclerosis of native coronary artery), instead of 414.01 alone, it is ‘over-coding’ and would be considered as a fraudulent activity by the corresponding statutory authorities.

Under-coding is usually a result of ‘fear for denials’. The best solution is to do ethical coding using coding and quality control veterans. Besides, perform NCCI (National Correct Coding Initiative) or other appropriate edits to ensure correct coding and to control the inappropriate assignment of codes that result in improper reimbursement or penalty.
Example: Some physicians consider 99213 as the default code as they believe much documentation will be desired for coding anything higher and they deem 99213 is the safe and sound option. But, in point of fact, this is an under-coding and culminates in diminished reimbursement.

The Soul of Medical Coding Remedies :

In a nutshell, our think tanks say that the following tips can augment accurate coding, and sequentially, medical practice revenue vanished to denials:

1. Keep your staff abreast of the revised codes.
2. Educate your staff to hone their coding skills.
3. Create a channelized workflow between coders and physicians.
4. Follow ethical coding practice.
5. Resubmit denials earlier and rigorously track the denied claims.

Click here to have a word with MedicalBillingStar and crash the coding menace effortlessly !

Dont let 55,000 more Codes Faze you !

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Is 10.1.2014 a Date set in Stone ?

Much to the consternation of physicians, according to the department of health and human services, it most certainly is. After frequent postponements, much hullabaloo and divided opinions, a date has been finally announced to make the transition.

Though the granularity in codes can lead to more clarity and a more structured coding system, most codes physicians fume, are never going to be used.

An Expensive Change !

Change comes with its own baggage. Now healthcare providers will have to make major changes to the infrastructure and workflow of their practice, to accommodate the revised coding system. One of the biggest roadblocks is to train staff and set up a testing schedule, amidst busy workdays. The slew of recent changes in healthcare informatics and billing regulations is going to leave physicians with little time to catch their breath.

What Defines ICD 10 ready ?

This is a question that stares at the face of every healthcare provider today. Most find working with codes that are not going to be of any purpose or use till 2014 a drain of time and human resources. But, the time to start gearing up for the change is, now !

Small Steps can make Huge Strides.

Small steps can shorten the path to adapting to an entirely new coding system. One easy way for medical practices, to stay ahead of the curve is to have a database of ICD10 codes that they’re most likely to use. This will get the “55,000 more codes” scare out of the way.

Assess the Impact of ICD 10 .

Performing a realistic and comprehensive assessment of the impact that ICD10 is going to have on your practice is essential. Draw a bucket-list of the aspects of your workflow that are going to undergo major change during the transition, and start a testing plan on them. Educate staff members or if you work with a vendor request for a detailed plan of action to deal with the onslaught of codes.

Being quick and informed can beat those deadline blues, and make your practice truly ICD-10  ready ! Whether you are planning on creating a training program for your team or ask your ICD-10 medical coding services company to set up an implementation plan, do it today !

How can Multispecialty Hospitals Tackle the Challenges Ahead?

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A busy multispecialty hospital resembles a war-zone. The audit issues, billing hassles and operational pitfalls faced by multispecialty hospital are more difficult to manage than the challenges thrown at single specialty hospitals. Office managers of multispecialty hospitals feel that they’ve bitten off more than they can chew. Keeping in line with almost unfair demands and regulations can be a nightmare.

 

Frequent Audits give Sleepless Nights  !

Facing billing audits can scare the daylights out of physicians. CMS has placed the onus on healthcare providers to create and maintain evidence based precise billing information. In a large scale set up the costs and infrastructure needed to maintain accurate medical documentation belongs to the realm of wistful dreams.

The billing regulations for each specialty, varies and a little slip-up can lead to the hospital being booked for fraud and abuse. But this not the only roadblock multispecialty hospitals face.

 Zeroing in on a Compensation Formula that works for Everyone…

Well, coming up with a compensation formula that makes everyone happy can be an uphill climb. Multispecialty hospitals have on board, specialists from different medical specialties, surgeons and imaging technicians. To come up with a compensation formula that is fair and in compliance with all regulatory controls, in today’s tough healthcare climate is almost next to impossible. It requires enormous amount of time and understanding to whip up a solution that makes everybody smile.

Is it the Best time to become a part of Multispecialty Groups ?

Surprisingly yes! According to the Great American Physician Survey an increasing number of physicians prefer employment than to start a practice of their own. This attitude shift is attributed to the responsibilities a medical practice owner is likely to face.

Working with Off Shore Firms…

Outsourcing medical billing needs is one way of ensuring profits and operational ease in a multispecialty set up. Hiring, training and monitoring large team of billing and coding professionals can only add up to expenses. To scale down on the efforts and money spent on the everyday workflow of a hospital, outsourcing is the preferred choice.

It will give doctors more time on their hands to fix a workable compensation formula, keep regular tabs on their workflow and keep abreast with changing guidelines and reforms. As most medical billing companies work round the clock the response time for additional documentation requests is swifter and being swift is best way to handle the challenges ahead for multispecialty hospitals.