Pitfalls to Avoid in Urology Medical Billing

The first thing to remember in any medical practice, including urology, is that the financial backbone of your urology practice is directly correlated to stringent coding, timely billing, and account reimbursement

Are you losing nearly 20 percent of your medical revenue? If yes, then you need to reassess how your urology coding and billing process is being implemented. If claims are wrongly coded and thereby wrongly billed, then your claims rejections or denials could be high and without documented proof of ‘incidence to” can lead to impacting your Revenue Cycle Management (RCM) cycle affecting cash inflow.

As a specialty, urologists need to take utmost care especially of the claims process, which involves the coding and billing practices. Here are some pitfalls if avoided during this process can help negate the decrease in cash inflows

  1. Coding errors with respect to modifiers need to be rechecked when billing against documentation
  2.  Review all ICD-10 codes as Medicare, beginning Oct. 1, 2016, will require more definitive diagnosis codes and will no longer accept family codes or codes that are unspecified. Proper ICD-10 diagnostic codes should be implemented and updated as per the regulations
  3. Remember that diagnoses can never be used to determine appropriateness of CPT codes or compliance.
  4. See to it that all communication channels are open and clear, and gaps in workflows are ironed out between the billing staff and clinical staff, especially when the focus is diagnosis related and based on non-specific diagnosis codes.
  5. Stringent documentation should be followed when coding for ipsilateral, same side, multiple stones.
  6. Knowledge of Medicare reimbursement rules and other carrier rules should be well-known to avoid rejections and denials. Sometimes what Medicare does no pay for, other carriers may depending on the codes used- this is a complicated process and hence both medical coders & billers need to be aware of the details of the patient against whom it is being billed for.
  7. Pay specific attention to claims denials and requests. It is noteworthy to remember that not all denials are ICD-10 related.
  8. Criteria for bundled procedure payment for primary procedure should be met with to avoid denials and/or rejections.
  9. Top priority should also be given to the Physician Quality Reporting System which should focus on putting pertinent information like patient information on important population health diagnosis codes, especially chronic kidney disease, hypertension, heart disease/failure, chronic obstructive pulmonary disease, osteoporosis, etc.

With the Merit-Based Incentive Payment System (MIPS), kicking in all practices including urology will be impacted and greater vigilance will need to be paid to the coding and billing process, so as to avoid claims denial which impacts the revenues of any practice including urology. Focusing on the above listed points will help decrease the errors while billing in your urology practice.