We can’t overlook the fact that medical billing is getting complicated, with more stringent rules being implemented on a frequent basis. Healthcare providers are always challenged with the risk of bankruptcy, as they face hurdles in maximizing their revenue due to rejected claims owing to some inaccuracies in medical coding and claims filing process.
We at Medical Billers and Coders are involved in continuous research to stay up to date with the current billing rules and trends. Here are some essential medical billing and coding tips, highlighting the common, but critical inaccuracies that tend to pass by unnoticed.
1. Spending too much time on counseling? Remember to charge extra.
As per the current CPT guidelines, you can use a higher level E/M code, based on the additional time you spend on patient counseling and coordinating their medical care procedures, regardless of the complexity of the diagnosis or the care procedures themselves. However, you can’t essentially count in the time spent in coordinating patient referrals or while reviewing the patient records for arranging the preliminary visit.
2. Using the -25 modifier code? Pay close attention to documentation.
When you attach a modifier -25 to your documentation to file for two separate claims for an E/M service and a procedure, clearly specify the details of each of the tasks performed. For instance, if a patient walks in for a routine health check-up and you also end up treating a foot corn, do ensure that you include the depth, width, and location of the corn, in addition to the details of your analysis and evaluation.
3. Separately charging a patient for an E/M service and a preventive procedure? Make sure you’re billing correctly.
If the preventive procedure you have performed is closely associated with the chronic or the acute medical condition you are treating her primarily, then your E/M code will not be validated. You can only bill an E/M service and a preventive procedure separately if the two are potentially unrelated.
4. Avoid under-coding your bills by being attentive to the amount of decision making involved.
Many physicians tend to code their bills based on the complexity of the diagnosis, overlooking the intricacies involved in the managerial aspects of care. This often leads to a 99204 or 99214 (level 4) codes to be incorrectly coded as 99203 or 99213 (level 3) codes, respectively. Patients can be coded as 99214 if you fulfill two out of following three parameters:
- A detailed patient history
- An intricate physical examination
- Moderately complex decision making involved in the process
5. Correctly code Medicare Part B beneficiaries
Medicare patients are entitled to a “Welcome to Medicare” preventive physical health examination to be conducted within the first six months of enrollment. Do ensure that you include a checklist in the patient records, indicating that you have addressed the seven key elements from the welcome pack.
6. Avoid some of these common coding errors, like:
- Associating incomplete codes with incorrect test case numbers
- Relying solely on coding software and not maintaining manually administered code books
- Missing to attend to critical specificities during medical coding
7. Outsource your medical billing and coding to experts.
Considering the complexity involved throughout the different stages and processes involved in filing for medical reimbursement, you can even choose to outsource your billing and coding responsibilities to expert medical coders in the industry.
Renowned and successful medical billing service providers like Medical Billers and Coders have been helping practitioners of medicine and many healthcare organizations file accurate claims and follow-up on AR to secure timely reimbursements.
Billing service providers are highly knowledgeable and experienced in dealing with federal and commercial payers, and they have been observed to help healthcare providers save on a lot of time and personnel costs spent in managing and regulating the billing process.