Physicians Practice - March 2008 - (Page 42)

BILLING AND COLLECTIONS procedure coded was for a colonoscopy. You’d know right away that something was wrong; that’s what payers see, too. But most CPT/ICD-9 problem pairs aren’t this obvious. “You’d like to think [the edits] are built on common sense, but one of the things we see is … CMS issues a coverage determination, and then it’s up to the individual contractors to determine how they are going to operationalize that,” Wolf says. In other words, every Medicare carrier, and every commercial payer for that matter, may have its own rules about what can be billed with what. Mismatches can also occur because of failure to follow the dreaded Local Medical Review Policies or National Coverage Determinations. These are Medicare’s policies about what carriers will cover. Commercial payers roughly follow Medicare, but also make up their own rules on what is OK to do for every possible diagnosis. Bundling edits are another mess. Every payer makes up its own rules as to what services it considers part of a larger service. If you send it a bill for two services, it will bundle it and pay you for one. That’s an accounting nightmare. Plus, if your practice isn’t on its toes, you may miss the chance to appropriately unbundle the services with a 59 modiﬁer, or payers might suggest that you are purposefully trying to overcharge them. Between the complexities of basic coding, medical necessity edits, and bundling edits, “it’s really mind boggling,” says Ken Bradley, Navicure’s vice president, transaction and interface development. “It’s basically impossible unless you do practice with a single payer, but that’s not a common situation. Payers are certainly not going to tell the practice how to ﬁle a claim for maximum reimbursement.” So, what to do? It may help to have your billing staff organized by payer, so that they gain expertise in the rules of individual companies. But an increasing number of physicians are also investing in technology that keeps track of all the edits for them. (For a description of the options, see “Coding Made Easier” from our July 2007 issue. You can ﬁnd it at www.PhysiciansPractice.com). Even with technology’s help, coding rules may seem overwhelming. Take the time to track the major errors in your own practice; they may well be one of those listed here. Then focus on ﬁxing one at a time for better results. Your goal: Reduce the number of claims that need to be reworked. “The goal is always that your collectors are exception processors. They shouldn’t touch every claim,” says Ratcliff. • Pamela Moore is senior editor for Physicians Practice. She can be reached at pmoore@physicianspractice.com. 5 QUICK TIPS Simple ways to get paid • Update your charge slip or super bill at least once a year. CPT and ICD-9 codes change annually. Make sure your charge slip stays up to date so you can code to the highest level of speciﬁcity and don’t use deleted codes. • Get a new HCPCS book every year. The codes you need for medications and other supplies also get updated every year. • Pay attention to injection coding. Too many bill just for administration, not for the material itself, or vice versa. Remember that Medicare typically has different codes than commercial payers for immunizations. • Do a quick spot-check of claims for typos and blanks before hitting send. “Most of your errors really come from simple mistakes,” Alverson says. “You transpose an ID number, or leave an ID number out, or get a patient’s new insurance card but it doesn’t get onto the claim. Everyone is in a hurry, everyone is asking you questions, you are trying to accommodate so many people, it’s easy to make mistakes. I tell staff, ‘Every time you key in an ID number, look at the screen and look at the card and make sure it’s right.’” • Appeal denials daily. It’s too hard psychologically to tackle a pile of claims that need to be reworked, and waiting just delays payment. Work to minimize denials, but if you do get one, appeal as quickly as you can. WWW.PHYSICIANSPRACTICE.COM 42 | PHYSICIANS PRACTICE | MARCH 2008 http://www.PhysiciansPractice.com http://www.sullivan-luallin.com http://www.sullivan-luallin.com http://WWW.PHYSICIANSPRACTICE.COM

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

Physicians Practice - March 2008 Contents The Bigger Picture: Try a Little Tenderness Second Opinion Letters Physicians Practice Pearls: The Value of First Impressions Noteworthy Cover Story: Your Complete Guide to Patient Service Billings & Collections: Rules to Code By The Administrators Desk: Selecting an EMR Technology: Learn to Love Your Nerd Ask The Experts Coding The Guide The Tech Doctor: All About Blogs The Great Practice Makeover: When Bad Things Happen to Good Practices Start It Up - NEW! The Law: Audits 101 In Practice: Do As I Say... Pretty Please? Healthonomics: Handling the Changes Wrought by Medicare D Classifieds Advertiser Index

Physicians Practice - March 2008

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