1. Verify physician coding. Since physicians often code to identify multiple procedures or diagnoses, they sometimes miss or inaccurately record the modifiers. Coders can change the modifiers themselves. For larger corrections, the coder should consult with the physician to make sure the reported procedures are accurate. Often, the coder receives the charges before the dictation, so speaking directly with the physician is necessary.
2. Code for performed procedure. Some procedures are not profitable for physicians to perform because payors do not fully reimburse for them. As a result, physicians will sometimes inaccurately report codes based on compensation instead of the actual procedure. “It’s difficult especially in today’s economy for doctors to understand that the coding is based on the procedure performed, not on the compensation,” says Ms. Henderson. “The doctor needs to understand the patient needs a procedure but they might not be paid for it.”
One change some physicians are making is to push for patient-pay options, such as for plasma injections instead of the standard steroid injections.
3. 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. 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.
Contact Ms. Henderson at cseal@mumedical.com.
Read other coverage on medical coding.
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