How can you avoid HBOT denials for Wound care billing?

March 31, 2017

How can you avoid HBOT denials for Wound care billing?

With the implementation of the new CPT codes for 2017, updates and changes for wound care and hyperbaric billing and coding has become an essential part of your practice. These updates have both positive and negative impact, meaning it can bring about new income avenues or severe reductions on your reimbursement sum, if your facility is not amending to regulations.

Here are 10 tips to avoid HBOT Denials for Wound care billing

  1. Know the Local Coverage Determination (LCD) for hyperbaric procedures for Medicare patients and audit it regularly. Things change rapidly in the Healthcare industry. Most LCD's will have a list of codes that supports therapeutic needs and clearly produce the documentation necessities to legitimize the treatment. Audit the patient record before starting the treatment to ensure the documentation meets those necessities.
  2. Know in detail your private insurers plan for hyperbaric medicines. Healthcare policies are essentially the LCD for private payers. Look online for the insurer's hyperbaric medical policy and analyze the documentation against the policy prior to starting patient procedures.
  3. Look beyond Authorization. You get the authorization, only to realize later that the patient's health plan not cover hyperbaric medicines. After you get the approval, address somebody in benefits to confirm the patient's financial responsibility. Ask questions to find out if the patient has hyperbaric benefits, their deductible sum and what amount has been met, and also their yearly 'out of pocket max'.
  4. Error free billing and coding. With the new CPT codes in place, it has become very vital for wound care facilities to jot down the codes for billing each treatment given to the patient. If you are having difficulties in producing error free claims, hire an offshore wound care billing agency for an optimized Revenue Cycle Management.
  5. Agreements on Single case. If the patient does not have benefits which cover hyperbaric medicines, it is beneficial to acquire a single case agreement. Your patient billing department should know this procedure to yield some satisfactory repayment, as the main priority to start the claims procedure. It might take time between the two parties, but is worth the wait and attempt to treat the patient in your center rather than sending to another facility. Remember to also get a single case agreement on behalf of the supervising physicians.
  6. Insurance. When requesting approval, guarantee that any supervising doctor of hyperbaric treatments partakes with the patient's insurance provider.
  7. Get in tune with the sixteenth minute rule. Hyperbaric procedures for Medicare are repaid in 30 minute fragments starting from the time the door of the chamber is closed and ending when the door of the chamber is opened. To justify billing for the next subsequent segment, the time must reach towards the 16th minute of the next 30 minute segment. Otherwise, you will round down to the previous segment. The times noted on the procedure chart will justify the segmental billing and coding.
  8. Diabetic Foot Ulcer. The restorative record for diabetic foot ulcers ought to have a statement with respect to sufficient glycemic control, offloading, and debridement.
  9. Medical Documentation. The medical documentation ought to have articulations with respect to the doctor's supervision, accessibility and sometimes, availability of emergency and additionally ICU administrations.
  10. Review and re-assess frequently. Using audits is vital to avoid denials and additional costs to both the patient and the overall healthcare industry. This justifies claims processed with treatment, if change is seen and discontinuation, if the patient's health is not improving. Patient evaluation is recommended to occur after 20 treatments and then ten treatments each after that. Do remember that most indications should not exceed 60 treatments.

Category : Revenue Cycle Management