July 22, 2015
Wound care involves evaluating, management, and treatment of non-healing wounds. Wound Care, a subspecialty in the medical practice, now ensures that the Wound Care professionals are geared up to the challenge brought in by the new healthcare reforms and ICD 10 coding guidelines. With the new Affordable Care Act (ACA) coming into force, physicians are finding it a challenge to integrate all these guidelines in their coding and documentation and still provide quality care to patients.
Moreover, Wound Care is being minutely looked at by the RAC (Recovery Audit Contractor), and especially when payer’s and clinician’s perspectives differ, debridement documentation may not stand up to the RAC audit. And to cap it, Wound Care professionals face – ever changing CMS rules & regulations, the presence of co-morbidities that exist in an average wound patient, the coding of modifiers, debridement’s documentation issues, all make for an abscess waiting to burst when it comes to Wound Care billing services.
The crux of Wound Care billing problem emerges when the clinical staff have no answer as to what they are being paid for, and when denials in the Wound Care billing rise. In order to avoid high denials, outsourcing can come as an effective alternative to your in-house billing. Other than denials, outsourcing can also help in the other facets of medical billing and streamline your business. Here are few reasons why you could turn your attention towards outsourcing your Wound Care Billing:
Presence of Statistical anomalies:
It is a well known fact that nearly 20% of Medicare fee-for-service beneficiaries are being readmitted within 30 days and 34% within 90 days. Can your staff handle this kind of readmissions? Is the documentation of them done as per the standards required? When you outsource, the billing company handles the tracking of potential readmissions and the respective coding and billing done appropriately so as to not attract the RAC in charge.
Distraction rather than concentration on core practice:
With the changing healthcare regulatory practices, one can easily get distracted from one’s core practice. When you outsource, it is the expert billers and coders who concentrate on their jobs of keeping updated and giving you quality service. For example, are your coders and billers aware that when Wound Care services are not performed by a therapist, certain therapy modifiers or revenue codes cannot be reported by providers of the outpatient perspective payment system?
Insurance coverage policy complexities:
There are a host of coverage policies both, Government as well as private insurance that patients avail of. How much of medical as well as insurance coverage knowledge should your staff know? How will they know whether the Centers of Medicare and Medicaid (CMS) will reimburse the wound treatment? The absence of clear national standards and frequent random changes in guidelines by regional Medicare intermediaries or private gives the individual auditor an even more discretion in how they interpret medical necessity. By outsourcing, you let the experts handle the nitty-gritty and fine print.
Are your coders rightly coding E & M Codes
It is a fact that, over the years, out-patient Wound Care has been billed with the use of E & M codes (Evaluation and Management codes). It was reported by the OIG (Office of Inspector General) in 2010 that approximately 1,700 providers were identified as billing higher level E&Ms 95% of the time. In case this happens, the pay-outs will be major and focus on whether payments for E/M services performed during the global periods of other procedures were appropriate. How well aware is your billing staff that ‘sometimes therapy’ codes differ based on the provider and circumstances under which it is delivered?
These are but a few reasons why you could have outsourcing as an option. There exist a host of other reasons though, why you should choose to outsource wound Care billing service rather than go at it yourself.
Best Billing and Coding Practices