Anyone who uses AthenaPractice (formerly Centricity Practice Solutions) wants to maximize their practice’s revenue. However in the end success hinges on sending clean, accurate claims that meet all the reporting guidelines. In addition, tracking denials and filing appeals in a timely manner is key, Some problems with reimbursement can be traced simply to the need for better organization and assignment of duties within the billing office, while other issues such as obtaining accurate to patient insurance coverage need to be handled by your front desk. Below are six ways to improve coding and compliance that will increase revenue:
Keep current on coding regulations and resources
In addition to CMS requirements to be compliant with implementing the new ICD-10 codes, the AMA annually revises its CPT books for additions, deleted codes and revised guidelines. Your practice should be using the latest resources to ensure compliance and correct reporting.
View denials as a learning experience
One of the most important things staff can do to prevent future denials is to take time to evaluate denied claims, especially if, as recommended by the MGMA, your rate of denials exceeds 5 percent. While software is available for identifying and catching mistakes before they are submitted such as the one Health 1 billing services uses, in its absence, your staff may need to pay closer attention to the following common reasons for denials:
- Missing pre-authorization documentation or missing a signed Advanced Beneficiary Notice of Non-coverage.
- Whether the patient was ‘new’ or ‘established’ as many E & M codes are based on this distinction.
- Missed deadlines – providers have their own deadlines, so pay attention to these.
- Conflicts over which payer is primary and which is secondary – your front desk should be verifying correct insurance coverage with each patient encounter.
- Benefits are denied due not being a covered item. Again, this can be easily remedied by checking benefits before undertaking a specific plan of treatment.
- Are there any payers who tend to deny more often? If so, these are the ones you want to be sure to send clean claims to the first time out.
Bring physicians and others on board with coding
Having a coder accompany providers to write down information and compare notes later with the provider may reveal that physicians and others omit critical information in notes, such as reading x-rays or reviewing lab reports – if it isn’t noted, it will be undercoded, costing the practice money. Spending a few minutes at monthly staff meetings going over notes with coders can also help providers with accuracy in documenting for improved coding.
Designate an in-house claims tracker
If the size of your staff permits, assign one person to be responsible for identifying and flagging claims that are reaching the deadline for resubmission or appeal of denied claims – and that any additional required documentation is updated and ready to send as well. Part of this job should include keeping an eye on resubmitted claims to ensure that the payer did indeed receive any resubmission in a timely manner, as well as follow their progress through to receipt of reimbursement.
Read provider or clinician notes fully before coding
Coders need to take the time to read through a provider’s notes to verify that no necessary information is omitted, especially if just reading through the headers and not the body of the note. For example, the body may hold more diagnostic information that would enhance selecting the most precise code.
Partner with an experienced medical claims services company
Health 1 understands the importance of having a Centricity and EPIC Medical Billing Service you can trust. That’s why we focus on providing the best service possible and being completely transparent. We are focused on collecting the maximum revenue for your practice as quickly as possible while helping to alleviate costs and hassle for your organization and providing great customer service. As a result, our Client financial metrics are ranked in the 99th percentile according to MGMA standards.