Primary Care 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 at the same time you can let them know that there are 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,- she says. She suggests that you ask yourself the following questions to uncover hidden revenue:

1. How many denials do you receive due to errors in the registration process? (For example, incorrect insurance billed, the insurance is not primary, unable to ID patient, patient was not eligible on the date of service, missing authorization, no referral, the service is not a covered benefit, etc.)

2. How much do you spend on patient statements/collection efforts every 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? (For example, missing fifth digits, invalid codes, diagnosis codes that do not match procedures, missing modifiers, etc.)

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

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 and in a timely manner? Is each and every denial 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 all outstanding claims 30 days and older? 

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