I’ve always been an advocate of effective marketing, but the truth is that having a lot of patients does not always equate to an increase in revenue.
You’ve got to be able to bill effectively for your services.
Look at it this way. If you have a lot of patients, your financial systems (billing and coding, in particular) matter more than ever. You need to have the right systems for:
- Patient payment policies
Good news right?
I asked him a simple question.
His answer surprised me. Although the number of new patient visits in his clinic had gone up by 84% in the past six months, his net income had gone up only 28%.
I asked him a series of questions using the checklist I have created over the years, and determined there were FIVE big mistakes his office was making from a billing and coding standpoint. Chances are, your office is making the same mistakes and these could be decreasing your revenue.
There are two types of ICD 9 codes in your initial evaluation; the medical diagnosis ICD 9 code and the treatment diagnosis ICD 9 code (designated by the therapist). Any mistake in entering the ICD 9 codes, such as the inability to enter all digits will result in a claim denial. In addition, with ICD 10 coming up in October 2014, the total number of codes in the library will increase from around 15,000 codes (currently in ICD 9) to over 55,000 (with ICD 10). It’s more important than ever to start becoming familiar with ICD 10 coding terminology with the impending changes coming up. The depth of diagnosis codes is also important. This means that you can, and should have more ICD codes in your evaluation so that you are very specific with your diagnosis and paint a clear picture about what’s going on with that patient. If you are ever audited, your ICD codes and CPT codes must ‘match up’ precisely with the billing statement, otherwise you could face financial retractions from the payer.
The best way to contest denials as a result of authorization errors is to document the name, agent number and start and end time of these calls. The insurance company does maintain a record of most calls, and if you provide them with specifics to retrieve the call, you’ll increase your chances of successfully contesting a claim.
In addition to unbundling of services, the incorrect application of Medicare’s 8-minute rule can result in your office overbilling or underbilling or your services. The individual handling your billing should be able to differentiate between timed codes (requiring face to face interaction with the therapist and direct supervision) and non-timed codes (can only be billed for one unit per day and do not require the therapist’s direct supervision) in order to bill the appropriate number of units for each patient visit.
Compatibility between CPT code and diagnosis code is critical. Did you know that codes have to match, and this is not only payer specific, but also state specific? If the ICD and CPT codes don’t match up, your claim will be automatically denied. Discipline specific modifiers like GP can be used extensively, but modifiers like the KX modifier and modifier 59 have to be used sparingly. Modifer 59 in particular is a red flag for insurance companies. CCI edits were developed by CMS to govern the use of modifier 59 and to avoid unbundling of services. CCI edits check for mutually exclusive code pairs.
It’s our responsibility to educate patients and let them know about their financial responsibilities and payment options. Most patients are unaware of their copays and deductibles. In most cases, a patient is a very difficult payer. Therefore, it is critical to explain the financial responsibilities to the patient and get their agreement in writing.
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