To accelerate cash flows for your wound care practice, invest time and create best practices/strategies for processes and revenue cycle management (RCM) policies and workflows which are essential to sustain a practicable business. RCM policies should include apt billing and coding, patient registration, compliant billing, query and denial management.
Using professional coders working for your wound care practice is usually rewarding. They are educated in the rules and regulations, and payment changes of Medicare, Medicaid and other insurance payers. They review local area determination for regular changes, update the charge description master reflecting the new codes and changes, and create a transition memorandum to reflect the latest changes. Apart from exact documentation required from Medicare for timely and accurate reimbursements, coders' code for all wound care procedures and services conducted. These are habitually in accordance with the HCPCS rules and codes.
In-house coders are sometimes not specialized in coding accurately (correct diagnosis codes with treatment codes). Also, due to a number of rules for wound care and hyperbaric oxygen treatment coding, a number of denials are received by the hospital leading to a loss in revenues. Thus, professional coders' come into play in aiding in increasing reimbursements for wound care, and assist in gaining payments through value-based purchasing and incorporated models of care.>
Many times, professional coders work from home, by logging on to a hospital's system (eliminating geographical barriers) and are more so required for rural hospitals engaging in wound care facilities. Professional coders usually have college degrees through which they learn to code accurately, read the documentation and query them if required, and are knowledgeable enough to take on the questions and challenges posed by CMS during RAC audits, thereby displaying excellence in tackling major/minor issues. They assist in decreasing inaccuracies related to data and duplicated tests which usually would have led to high financial losses.
With the new Affordable Care Act, it does get a little traumatic for physicians to involve themselves in coding documentation rather than patient care. Along with this, the ever changing CMS rules, coding of modifiers and other debridement documentation issues, tend to mess up the revenues. Hence, professional coders from outsourcing companies are ever too keen to help. They are aware of fine distinctions; for e.g. - if the wound care services are not conducted by a therapist, certain therapy modifiers and revenue codes cannot be used. They are also well aware of the coverage policies of government and private insurance payers, or random changes in their guidelines which ultimately affect revenues. Wound care involves with Evaluation and Management Codes (E&M Codes); however professional coders are aware that 'sometimes therapy' codes are different based on the healthcare provider and conditions under which it is provided.
It is the professional coders' mandate to understand the physicians' documentation, to appropriate bill and code for wound care billing services, and to lead the path for lesser denials eventually soaring cash flows.Back