1. Familiarize yourself with payor regulations. When a payor rejects a billing claim, the coder must research and pinpoint any inaccurate coding and fix the errors, such as bad modifiers or bad diagnoses, says Courtney Henderson, CPC, CPC-P, billing supervisor for Mu Medical Management. Most payors require a physician’s note verifying elements of the corrected claim. If the physician mistakenly performed a procedure the payor will not cover, the claim is written off.
Mistakenly billing payors commonly occurs when payor regulations change, such as when Medicare removed the consultation code, ceasing to compensate for consultation visits. Initially, some physicians forgot and tried to bill Medicare using the consultation code. In order to avoid returned claims, Ms. Henderson suggests visiting company websites and becoming familiar with payor rules.
2. Learn to speak “code.” For most accurate billing results, Wendy Owens-Frierson, CHM, CHI, CPC, CPC-I billing products manager with Avisena, recommends physicians use the “coding” language in their reports instead of describing the procedure as a narrative. “When physicians are not using the coding language, there’s a loss in revenues,” she says. “The documentation is key in selecting and capturing all the appropriate and billable codes.” By becoming familiar with common codes for each step of the procedure, physicians can better relay the procedure performed to the coders which results in more accurate billing practices and increased revenue.
3. Amend documentation in writing. If the coder has follow-up questions regarding the documentation within the medical record, clarification should be requested from the physician, says Mona Kaul, chief coding and compliance officer of GENASCIS. All changes to the documentation must be made in writing and added to the patient’s record for possible future reference. Do not accept verbal direction as it may be subject to interpretation and is not part of the permanent medical record.
4. Invest in code deciphering software. If a practice has not staffed a professional coder to decipher the physician’s report, coding software can help the physician identify the correct CPT codes from the claim documentation. The physician downloads surgical reports and the software assigns CPT codes for the claim, which Dave Wold, CEO of Healthcare Information Services, says certified coders identify as accurate 80 percent of the time.
Coding software also allows the physician to design individual payor edits and regulations to ensure claims are appropriately filed and will not be returned. This eliminates the need for manually entering codes into the claims. For the best results, Mr. Wold suggests physicians speak with certified coders about key words to use in their reports for improved accuracy during the transcription between codes and physician documentation.
