Best Billing Practices

Haidy Rodriguez PhotoBy Haidy Rodriguez

Physician practices with Medicare patients should start the year by giving renewed attention to detail on billing. They will likely discover opportunities for revenue and maximize what they think – but probably aren’t – getting from the government program.

Here are five tips for a more productive and rewarding 2015 through improved billing practices.

File for payments with up-to-date codes

Just how old is your code book? If you’re using an outdated edition, you are missing out on new revenue opportunities. Did you know that you can bill Medicare for new billing codes such as Web conferences with other doctors, tele-health consultations and group sessions with patients who have the same disease on how to manage their condition?

Insurance billing is undergoing the same rapid changes as Medicare moves to ICD-10 on Oct. 1. That means a new level of compliance and a huge jump in the number of codes from 13,000 to 77,000. You’ll need time to get ready. And you’ll need a new code book.

Boost revenue by hiring a certified billing coder

With new Medicare standards and more complex billing procedures, it’s now a necessity – not a luxury – to have a certified billing coder. That individual helps a physician practice maximize revenue by including codes that capture overlooked revenue opportunities.

Physicians can find certified coders through the two leading national agencies, AAPC, the American Academy of Professional Coders and the American Health Information Management Association, or AHIMA. Both offer online courses and issue examinations in Florida. They also provide continuing education so that a certified coder knows the newest requirements.

Some doctors balk at the higher salaries that certified coders can command, but our experience shows that these workers more than pay for themselves by adding revenue, reducing penalties and, as we’ll discuss in a moment, interpreting the explanation of benefits.

A physician practice with an uncertified coder should pay for that employee’s training. The return of two to three times the investment, including higher productivity, makes this change for 2015 a no-brainer.

Find lost revenue in the explanation of benefits

It’s one thing for a physician practice to submit a bill; it’s another to make sure that it is paid in full. Sometimes Medicare will reject a bill and ask for more documentation. If no one in the physician’s office reads Medicare’s response, the doctor will lose an opportunity to collect.

Let’s say a physician performs an annual wellness visit under Medicare and discovers a health issue which she treats. The physician invoices for the wellness visit and treatment. Medicare rejects the second item and explains why. However, the doctor’s office sees a payment associated with the patient’s name and thinks everything’s OK. The lack of follow-up on the insurer’s response means that revenue was lost. Don’t let that office be yours.

Make sure you are billing for all services

A lot of billing houses are stuck in the HCFA1500 era, designed for the days when doctors mailed bills to insurers for services rendered. Besides killing trees, the system limits a practice’s ability to send in diagnosis codes. Under Medicare’s new pay-for-performance model, it’s no longer just about the individual’s urgent need, but also the underlying causes.

Here’s an example: a 75-year-old patient with diabetes and COPD sees her doctor after complaining of shortness of breath. Under the old system, the doctor treats the patient and she goes home. In today’s system, the physician manages not just the COPD, but the diabetes so that it does not complicate the COPD.

Medicare allots more money for treating that patient than a healthy one or one with just COPD. A modern billing system will report the patient’s full condition and what’s being treated. If that’s properly coded, the physician’s practice can earn more through the Shared Savings Program.

Think progress notes, not super-bill

Physicians find it quick and easy to check off on what they did – level of visit, injection, prescription – on a super-bill. But that misses a few things, especially those related to preventive care.

Let’s say a physician has been managing a patient for cholesterol and the proper level of medicine for COPD. Both of those treatments may not show up on the super-bill. By using progress notes instead, a practice can mine good information that produces additional billing opportunities.

Haidy Rodriguez is the director of quality improvement for Accountable Care Options, LLC.  She is a certified coder, auditor and patient-centered medical home content expert with experience in ACO development and direct patient care.

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