Compliance with medical coding standards is an essential aspect of healthcare revenue cycle management because it safeguards sensitive patient information and eliminates audits and revenue leaks.
ProFee, or professional fee, relates directly to physician coding and billing. The medical services rendered by the provider and the compensation for those services are both accounted for in ProFee coding.
With the shift from a fee-for-service to a value-based care model, maintaining financial stability in the healthcare industry has become increasingly difficult. There are various variables that can affect a clinic's income. Healthcare facilities should collaborate with their medical billing and coding firm to develop profitable tactics that increase reimbursement and income.
In this article, we'll go deeper into some of the tried-and-true billing and coding tactics that boost an organization's financial health by improving the performance of the revenue cycle.
1. Include Physicians and Others in the Coding Process
This practice could save money by having a coder tag along with providers to take notes and then compare those notes with the provider to see if they missed any crucial details. For example, if a doctor or other provider fails to note that they read the patient's x-rays or reviewed the patient's lab results, the practice will lose out on reimbursement. To better ensure accurate documentation for coders, providers can spend a few minutes at monthly staff meetings reviewing notes.
2. Knowledge of Telemedicine Service Reporting
Increased patient access and satisfaction rates can be attributed to the worldwide pandemic-driven uptick in the use of telemedicine technologies. However, healthcare organizations must stay abreast of the newest CMS revisions and rethink their telemedicine reimbursement strategy to ensure that distant healthcare services are fully compensated.
When reporting telemedicine services provided at a non-traditional location, coders should enter 02 for the Place of service. The use of synchronous patient-provider contact to provide healthcare services remotely may also need the use of modifier -95 from insurance companies.
3. Insurance Verification
You need to check off some boxes before an appointment to determine insurance coverage and patient responsibilities, including eligibility and pre-authorization. Verifying this information before a patient's visit can prevent delays or denials of claims, decreases in patient satisfaction, and even nonpayment.
4. Appoint an Internal Claims Tracker
If your team is large enough, have one person be in charge of keeping track of when claims need to be resubmitted or appealed and making sure all supporting materials are current and complete before the deadline. A part of this role includes monitoring resubmitted claims to verify that the payer received any resubmission in a timely way and to track their progression until payment is received.
5. Avoid Chronic Care Management (CCM) Denials
Payment companies are more likely to deny claims for the same patients if they are submitted later than 30 days after discharge. This is why digital patient engagement solutions are so important for hospitals and practices in the fight against readmissions and for achieving optimal health outcomes. It is important for practices to work with their specialists to identify who, if anyone, may be billed for the CCM and to file claims in a timely manner.
6. Utilize Modifiers Properly
Insurers can be alerted to potential extenuating circumstances through the use of modifiers in combination with Current Procedural Terminology (CPT) and the directions by Healthcare Common Procedure Coding System (HCPCS). Mistakes with modifiers can have a domino effect on the revenue cycle, leading to incorrect billing and, perhaps, denied claims. Coding errors can be avoided with the assistance of medical billing service firms because they employ certified coders.
7. Code Transitional Care Management (TCM) Correctly
There is a similar pattern of increased rejection in TCM. Care coordinators must contact recently released patients (by phone or in person) within two days of their discharge in order to collect accurate information to prevent TCM denials. Other crucial considerations include accurate recording of Admission Discharge Transfer (ADT) feeds, discharge summaries, and smooth integration of data into EHR administration.
Facilitating speedy patient interaction in an outpatient scenario for administrative staff. Reduce the likelihood of a claim being denied by providing the payer with complete and accurate documentation of the care provided, including information about the patient's discharge, the date of the call, a summary of the interaction, and any other pertinent details, which are especially important in high-complexity TCM cases.
8. Maintain Credibility with Coding Regulations and Resources
The Centers for Medicare & Medicaid Services (CMS) mandates that all healthcare providers adopt the new ICD-10 codes, while the American Medical Association (AMA) has updated its CPT manuals annually to reflect new codes, removed codes, and updated guidelines. To guarantee legality and accurate reporting, your clinic should use cutting-edge tools.
9. Check Claims Twice Before Submitting
A claim denial could result from something as insignificant as a misspelled word or a typo. The healthcare industry has a responsibility to guarantee that patients' and clients' information is entered correctly.
Medical codes have been updated frequently to account for the pandemic scenario. Therefore, healthcare providers must be prepared with this new information in order to maintain their status as industry leaders in medical billing and coding.
You can gain a competitive edge by teaming up with a competent healthcare revenue cycle management firm that uses cutting-edge billing software, follows standard industry procedures, and employs certified, experienced coders, to ensure correct billing and coding.
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