Physicians Practice - January 2008 - (Page 61)

CODING YOUR TOP CODING CONCERNS SOLVED CLEAN HOUSE IN YOUR BILLING OFFICE; DETAILS MATTER IN REVIEW OF SYSTEMS B Y B I L L D A C E Y, C P C Tired of not getting paid for your services? You might need to look at your billing ofﬁce operations rather than your coding habits. One large Medicare carrier reports that, for three large states in which it administers plans, practices’ top billing errors fall into the following six categories: 1. Duplicate claims. 2. Claims not covered by the payer. 3. Bundled services. 4. Beneﬁciary eligibility. 5. Medical necessity. 6. Noncovered services. patients’ coverage, the Correct Coding Initiative, and National and Local Coverage Determinations. Software can help. So can aiding staff in becoming experts in the intricacies of your major payers’ coverage policies. But better coding is probably not the answer. These are billing issues rather than strictly coding ones. Knowing the difference can save you enormous frustration and help focus your improvement efforts. And by the way, there is a denial review process for all payers, often with many levels or stages up to and including a face-to-face with the plan GET BUSY Enlist your staff to track the causes for the denials in your office and get to work improving your processes. medical director. Don’t be one of those physicians who just like to complain about not being paid. Make sure your billing staff knows the claims review and resubmission processes for each of your major payers. DETAILS MATTER IN REVIEW OF SYSTEMS Each of these errors originates in your ofﬁce and can be corrected. That means faster and more complete payments for you. Enlist your staff to track the causes for the denials in your ofﬁce and get to work improving your processes. To reduce duplicate claim denials, wait at least 30 days to resubmit a claim that appears to be lost in the system. (Of course, you should also review reports from your clearing house and immediately resubmit claims that didn’t make it through that ﬁrst step.) Reducing denials for noncovered services, bundled services, and medical necessity requires robust knowledge of WWW.PHYSICIANSPRACTICE.COM systems, a notation indicating all other systems are negative is permissible.” Physicians have long relied on this latter sentence to justify documentation conventions such as “ROS w/o negative,” “ROS unremarkable,” and “ROS noncontributory.” These statements seem broad enough to indicate the work performed with a minimum amount of documentation effort. Physicians appear intent on economizing in the documentation area while still expecting to receive compensation for their work. But WPS and Trailblazer will no longer accept “ROS noncontributory” as documentation. The language does not make it clear that the physician performed the work of inventorying the systems. Did she pose questions but obtain no relevant information? Or did she decide the review wasn’t relevant, and so did not do it? If the latter is accurate, then the E&M code is not appropriate. If payers are singling out “ROS noncontributory,” you can bet they’re also skeptical about the other abbreviations. Physicians should stop relying on convention to carry through a payer review. Just like your math teacher in junior high school, the payers want to see the work. • Recently, a few Medicare carriers, speciﬁcally WPS and Trailblazer, have required more speciﬁcity than ever before in documenting the review of systems (ROS). The 1995 and 1997 federal guidelines covering ROS state: “Systems with positive or pertinent negative responses must be individually documented. For the remaining Bill Dacey, CPC, MBA, MHA, is principal in the Dacey Group, a consulting firm dedicated to coding, billing, documentation, and compliance concerns. Dacey is a PMCC-certified instructor and has been active in physician training for more than 18 years. He can be reached at billdacey@msn.com or via info@physicianspractice.com. JANUARY 2008 | PHYSICIANS PRACTICE | 61 http://WWW.PHYSICIANSPRACTICE.COM

Table of Contents Feed for the Digital Edition of Physicians Practice - January 2008

Physicians Practice - January 2008 Contents The Bigger Picture: Fixing Medicaid Letters Physicians Practice Pearls: You Can Teach an Old Dog New Tricks Noteworthy Cover Story: Fee Schedule Survey: 2007 Results Adding Ancillaries: Bucking the Practice Ask the Experts Idealab: 'How I Got Over My EMR Excuses' Technology: Don't Be Denied The Tech Doctor: Blessing or Curse? The Administrator's Desk: Learning From the Best Coding Career: To Partner, or Not? Management: Controlling Your Inventory Human Resources: How to Fire an Enployee Finance: Beyond Reimbursment - How to Fix Your Mix Classifieds Advertiser Index

Physicians Practice - January 2008

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