March 07, 2014
A sound billing and coding process is very crucial for timely settlement of claims and ensuring steady revenue generation for your gastroenterology practice. All medical billing and coding practices must be kept in order to ensure that all claims are settled in an appropriate manner. It is important that your medical and support staff are aware of the correct coding and billing procedures. There are a number of questions and issues that may arise related to billing and claims. By following the following tips any Gastroenterology practice can avoid unnecessary delays in claim settlement.
Adopting latest ICD – 10 coding -
The foremost aspect of ensuring no delays in claim settlement requires that your Gastroenterology practice and its staff use the latest and updated coding, CPT and ICD-10 coding for specified medical procedures. This not only ensures correct billing as well as accurate records for later inspection.
Ensuring regular training-
The medical staff of your Gastroenterology practice must be trained in the latest practices, medical billing and coding processes. Regular training of the staff must be carried out as per schedule to ensure they are able to service all their patients’ needs. It also helps if the staff is trained for fee-for-value model and understands the concept of deriving satisfaction from a contented patient.
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Using correct coding levels for patients-
Using the correct level of coding for each and every patient according to their level of illness is very important to avoid cloning of claims. They must not bill all the patients at the same level as they cannot be ill at the same level and at the same time as some are in worse condition than others. An audit may result if such a practice is followed as the health regulators emphasis that all patients cannot be sick at the same level of illness.
Verification of patient benefits-
The medical staff must ensure to check with the patient for all copayments that are applicable, deductibles and co-insurance responsibilities. Verification must also be done for any specific approvals and procedures at the time of registration.
Maintenance of Accurate Records & Medical History –The importance of having accurate and up to date medical records of patients is very crucial. The staff must ensure that they collect a copy of the Government Issue ID and Insurance card with the full information of the insurance cover of the customer and use relevant coding and claims. It aids in correct and timely counseling of patients and reduces the chances of unwanted audits and delayed claims.
Correct follow up on tests -Your Gastroenterology practice staff must ensure regular and timely follow up of all the tests prescribed for the patients. The tests must be carried out in the correct manner, informing patients of all requirements in time. The detailed test results must be updated according to CPT guidelines in the patient records to avoid audits and delays during claim settlements.
Follow up Insurance – The practice of daily review of the accounts receivables is a sound practice to ensure timely payments. Monitoring of outstanding accounts and verifying the claim processing will reduce the number of claims.
Timely refund of credits to customers – A successful Gastroenterologist should make sure that the practice ensures all claims are processed in time and by following the relevant CPT and coding. A time barred method to ensure all claims are paid out will reduce claim settlement issues and delays.
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