Radiology Coding Alert

Tips: Keep documentation, adopt changes, train, retrain, and audit.

If your practice is plugging along successfully, but your revenue is still in a slump, take a look at your coding situation. Improper coding, inexperienced coders, and the lack of updated training and resources are likely getting in the way of your fiscal viability. Reassess where your practice stands for these three key focus areas.

1. Embrace the change: ICD-10 reforms have thrown challenges at you, but you needn’t be scared. Here is what you can do:

• You can look at possible tools to help your staff. You can consider training programs and invest in updated ICD-10 code books.
• Make it a norm to follow online coder alerts and utilize practice management and EHR programs that give ICD-10 updates in real time.

2. Make sure your notes and your codes match: Your notes should be able to justify what you have billed. According to the CMS Supplementary Appendices for the Medicare Fee-for-Service 2015 Improper Payments Report, insufficient documentation, lack of medical necessity, and improper coding are the three key reasons for improper Part B claims.

Note: To take a look at the CMS Supplementary Appendices for the Medicare Fee-for-Service 2015 Improper Payments Report, visit www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/CERT/CERT-Reports-Items/Downloads/AppendicesMedicareFee-for-Service2015ImproperPaymentsReport.pdf.

Quick fix: Embracing technology and all the services available now really can eradicate many of these issues. The upfront cost is worth the long-term gain – mobile EHRs, dictation software, a trained and certified staff, and crisp, new coding resources will put your practice back on track.

3: Train, update, and audit: From coding to compliance, a successful practice should be equipped with right tools and adept coders. You should acquaint your practice with CPT^®, ICD-10-CM, and HCPCS Level II coding guidelines and be well versed in revenue cycles, payer and patient requirements, reimbursement, and claims denials. Hire certified coders and regularly train them on the job. Plan for routine and ongoing training rather than just annual events to ensure your practice is in alignment with the rules, regulations, and needed laws and updates.

With all the advancements in mobile technology, practice management software, and EHRs over the last few years, it’s easy to keep up-to-date with CMS, ICD-10, healthcare trends and initiatives. A knowledgeable healthcare IT firm, who understands coding, HIPAA, and compliance, can evaluate what your needs are and adapt to your budget.

Checks and balances keep the healthcare industry honest from top to bottom. Annual audits, both internal and external, are necessary to see where you and your staff are succeeding or have room for improvement. This needs to be at the top of your checklist, especially in regards to coding errors and compliance issues.

For more information about coding certification, visit www.aapc.com.