Anesthesia Coding Alert

Turn a negative into a positive with these quick steps

Keeping your physicians from taking advantage of the so-called E/M "loophole" is a little easier if you educate them about other ways to find additional income within your practice--you just have to ask the right questions.

"If a physician is not satisfied with his or her reimbursement, there is a good chance other areas of the billing cycle may not be functioning as well as they could be," says Erica D. Schwalm, CPC-GSS, CMRS, billing and coding educator in Springfield, Mass. "I would take a look at the entire process, starting at the front desk and ending with accounts-receivable management."

Watch 8 Areas That Can Boost Your Claims

Schwalm suggests that you ask yourself these eight questions to help uncover hidden revenue:

1. How many denials do you receive due to errors in the registration process? Examples include billing an incorrect carrier, billing a carrier that's not primary, being unable to identify the patient, treating a patient who was not eligible for service on that date, missing authorization, having no referral, and providing a noncovered service.

2. How much do you spend on patient statements and collection efforts each month? Are you collecting copays up-front? Do you charge a no-show fee?

3. How many denials do you receive for coding-related or data-entry errors? Examples: Missing fifth digits on diagnosis codes, invalid codes, diagnosis codes that don't match the procedure, and missing modifiers.

4. Do you have a system in place to ensure that you capture all visits and bill for them (such as missing charge reports)? Are you sure all physicians in the practice are checking off or indicating every service and item they provide on their charge tickets?

5. Do you have someone in your billing office ensuring that payments received are correct?

6. When you do receive denials, is someone resolving them quickly? Is each and every detail analyzed and appealed, as appropriate? Does someone follow up on the appeals?

7. Do you have someone assigned to review the accounts receivable? Is someone calling on outstanding claims 30 days or older?

8. Do you look at your "write offs"? Are you sure your billing staff is doing what they should be doing?