Physician's Practice - November 2008 - (Page 37)

and assist with coding for every patient. In the real world, this will never happen. However, all physicians should have an updated charge ticket for every setting they work in. The key word is “updated.” So many practices are so busy they don’t take the time to update the charge ticket every year. This is one of the most important tools the practice will use. The charge ticket is the beginning of the revenue process. For example, if a physician routinely use the tickets. If you don’t explain what the provider can bill for, how can you expect the charges will be captured correctly? Physicians and nonphysician practitioners typically document the services they provide to their patients on a progress note, patient encounter form, or in an electronic medical record. Once the patient encounter is completed, the physician typically checks off on the charge ticket what services were performed. In a per- the practice has obtained a signed Advanced Beneﬁciary Notiﬁcation (ABN), which explains that the service is not covered, and that the patient will be responsible for payment. Physicians need to know when and if an ABN is required for Medicare, along with how to adjudicate the ABN. The key is consistent communication between the coder, data-entry, billing staff, and providers. The staff should feel comfortable going to the physicians with questions about the coding and charges reported. AVOIDING DATA-ENTRY ERRORS UPDATE YOURS So many practices are so busy they don’t take the time to update the charge ticket every year performs lesion excisions in the ofﬁce, and the code is not on the charge ticket, the procedure will be frequently missed. What about urinalysis or venipuncture codes? Modiﬁers? Keep in mind that in the ofﬁce setting, many practitioners perform minor procedures in addition to the initial evaluation and can report both with modiﬁer -25. CHARGE TICKET TIPS To ensure that you receive all the charge tickets from your providers, try supplying each provider with a set of unique, sequentially numbered charge tickets. You can design the charge tickets so they ﬁt into a small book that the providers carry with them. It should be the responsibility of the ofﬁce staff to make sure all the numbers are in sequence when the tickets come in; if a charge ticket is missing, staff should alert the provider. Second, make sure your providers are trained on how to WWW.PHYSICIANSPRACTICE.COM fect world, the physician will have a good understanding of coding and will know when services are bundled, when services can be reported, and when services are incidental. However, in the real world, that is not always the case. Take vaccines, for example. Can you charge an administration code in addition to charging for the vaccine itself? The answer is no, unless the physician provides counseling regarding the vaccine; side effects, beneﬁts, contraindications, and so on. Simply injecting the vaccine without that counseling is not a billable physician service. If your practice dispenses vaccines regularly, your physicians should be trained on the rules. What about a Medicare patient who had a Pap test and pelvic exam last year and insists on another this year? Medicare, which covers this service every two years, will deny the claim. The patient is not responsible for the service and cannot be billed — unless Faulty data-entry is another common cause of lost revenue. Charges are typically transferred through keyentry by a billing or data-entry specialist; it’s easy to make small errors that can lead to rejected claims. To reduce errors, data-entry staff should work uninterrupted in as quiet an area as possible while entering charges. Staff need to focus when entering data: Errors are bound to occur when the person entering the charges has other simultaneous responsibilities, like rooming patients and answering the phone. It might be a good time to take a look at ofﬁce work ﬂow and processes. Lastly, maintain the accuracy of diagnosis codes. If the diagnosis code is incorrect or not reported to the highest level of speciﬁcity, the service might be denied and the process of getting the claim paid will cause unnecessary delays. Diagnosis codes are updated every October, CPT and HCPCS codes in January. • Deborah Grider, CPC/EM, is a health- care consultant, author for the American Medical Association, and president of the American Academy of Professional Coders National Advisory Board, the nation’s largest education and credentialing association for medical coders. NOVEMBER 2008 | PHYSICIANS PRACTICE | 37 http://WWW.PHYSICIANSPRACTICE.COM

Table of Contents Feed for the Digital Edition of Physician's Practice - November 2008

Physician's Practice - November 2008 Contents Death of Solo Practice Just a Myth Letters HSAy What? Noteworthy Finding Lost Revenue: The Search for Billing and Coding Gold Getting More: Our Annual Physician Compensation Survey ’Tis the Season to be Neutral Ask the Experts Evaluating Paperless Labs HR in a Box? The Guide Coding Third-Party Audits on the Rise Branding the Cash-Only Practice Intra-Office Tug-of-Wars Stickin‘ Up For Yourself Classifieds Advertiser Index

Physician's Practice - November 2008

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