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Efficient Billing Practice to Aid Physicians amidst Continual Coding Revisions, and Avert the Possibility of Denials

April 02, 2013

Amongst the possible reasons for denials, coding inadequacies seem to have a major impact. Because codes quantify and qualify physicians’ medical services for medical reimbursements from payers, any inherent coding error, miscoding, over or under-coding can lead to denials upon found to be incongruent with acceptable coding practices. While a few coding manipulations may happen intentionally, most of the time it is the complexities of coding that often expose physicians or their staff to coding errors. With revisions made to CPT and HCPCS Level II codes every year, coding-related complexities are destined to multiply further. Failure to discern and apply revised coding systems may eventually result in disqualification or outright Denial of Physicians’ claims. As a result, physicians may have to forgo a considerable chunk of their revenues in the absence of remedial measures.

Even as most of the physicians have some form of in-house medical billing that addresses coding demands, the growing coding revisions and complexities require much more than simple form of in-house medical coding. It really takes an efficient medical billing management to monitor and resolve coding errors and denials. The value of such efficient medical billing management is that it can:

  • Renew your encounter forms or super bills and systems (where codes are stored and used for claim submission) as and when coding changes are announced.
  • Update physicians’ internal clinical documentation in a way that best suffices the demands of evolving coding revisions or changes.
  • Apply revised CPT coding guidelines to validate and minimize the risk of denials. It is noteworthy that such instant adherence to coding guidelines will naturally be appreciated by payers, which may be reflected in fewer audits and denials.
  • Bargain for better fee schedules based on revised reimbursement rates for the new and revised codes.
  • Help understand and respond to payers’ payment policies towards revised codes, establishing medical necessity of a medical service, and clinical reporting.
  • Employ National Correct Coding Initiative (NCCI) edits while resolve the bundling of codes.

Parallel to these comprehensive medical billing management initiatives, it could also monitor and resolve denials through:

  • Payer-specific report generation of denials using Review practice management system (PMS).
  • Discover the main reason behind denials, and resubmit claims with requisite modification and correction to codes.
  • Supporting the applied codes with solid proof of medical necessity of medical services

As physicians across the U.S. seek to adapt to evolving coding revisions – of which ICD-10 alone will have 70,000 odd PCS codes, it may seem difficult without experts’ intervention.

Medicalbillersandcoders.com has effectively positioned to play the role of a facilitator during this phase of coding transformation. Our affiliation with medical billing specialists – competent and experienced to bring about systematic elevation in physicians’ coding practices – should help physicians respond to the challenges of continual coding revisions, and mitigate the possibility of denials as far as possible.


Category : Best Billing and Coding Practices