Effective coding is the best way to fight off rising business costs in your medical practice. The procedural and diagnostic codes used to submit claims for reimbursements mandate how much your providers get paid for the work they do. Therefore, it’s essential to ensure your coding procedures are optimized for success. Below are five ways you can begin to code more effectively at your medical practice.
If your practice’s claims denial rate is higher than five percent, you need to identify the issue. The most common reasons for rejected claims include missing information, insufficient documentation, coding errors, and late submissions. In order to prevent rejected claims, you need good communication between your medical billing and coding staff,and physicians to ensure the right codes are being put on claim forms. Keeping the lines of communication open between your practice and insurers can be just as effective too.
Payers also frequently deny claims for services that are deemed “not medically necessary,” either because the diagnosis did not relate to the services or because it is only covered at certain rates. If this is the case, confirming insurance coverage and authorizations before each visit can minimize the number of denied claims. Being vigilant every step of the way, from booking appointments to submitting claims, is necessary to prevent coding error rates.
Being knowledgeable about your policies and communicating them effectively to your patients goes a long way. With a better understanding and communication of payment policies, your staff can work more closely with patients to verify correct insurance information, clearly explain the coverage policies of each plan, and submit claims accurately. Being clear about your costs is also important. Always tell your patients what treatments and procedures cost so they can determine if it fits their budget and is covered by their insurance. Check their coverage prior to their appointment as well to factor in all costs into your discussion.
The best way to help physicians improve their coding is additional training. Although your practice should already well versed with ICD-10, staying up to-date with a new coding system is difficult. You have to make sure you and your physicians are learning and complying with new coding and documentation regulations and standards in order to receive the maximized reimbursement for services. Although it can be frustrating, there’s no reason to let this affect the productivity and profitability of your practice.
At HIS, we offer medical coding training and ongoing education for our partnering practices to ensure your staff has the skills and training necessary to adapt to the transition. We offer on and off-site training programs to help your staff learn the fundamentals of current coding and documentation regulations. We also provide ongoing medical coding training that includes onsite instruction and 15 hours of continuing education units for your coders. With the right training, your practice will avoid simple mistakes that can lead to undercoding and coding errors.
If you notice that your medical practice has an increase in denied and rejected claims, taking the time to evaluate what’s going on and identifying if there are trends present is essential. For example, you may find that claims with one particular insurer are rejected more often than others. You may also find that a particular diagnosis code leads to more rejected claims, or that there are insurer requirements and payor specific edits going unnoticed causing increased denials. Identifying the reason behind the increase in denials and rejections can help your practice adjust policies and procedures to efficiently increase your clean claims rate.
Proper coding education for your physicians and office staff can mean greater revenue and more efficient operations for your practice. If medical coding is causing a problem in your medical practice, we can help you at Healthcare Information Services (HIS). We have over 65 certified professional coders that are capable of providing your staff medical coding education to improve overall efficiency and boost revenue.
Our mission is to enable your practice to collect the maximum reimbursements for your services, while also supporting the management side. This way you and your fellow physicians, nurses, assistants and staff can focus on taking care of your patients’ needs. We promise to effectively communicate with you and your practice, and go beyond your expectations. Contact us today for more information on our medical coding training and other revenue cycle management services.