Practitioners are always seeking new sources of revenue and skilled medical billing specialists can obtain those additional funds through entirely legitimate means. Medical billing isn’t confined to simple coding procedures alone and in this insightful article, Nitin Chhoda examines ways billers can create greater cash flow for the practice.
Needful and Medically Necessary
There exists a wide range of procedures and modifiers that insurance companies don’t cover. They’re considered cosmetic and viewed as elective treatments.
Depending on the procedure, it may be possible to obtain reimbursement for some of those procedures, such as reconstructive surgery. Obese patients who have lost massive amounts of weight may require loose and excess skin to be removed.
Other clients may need dental work that can be billed as a covered expense, along with rehab services. Practitioners should remember that health concerns aren’t limited to the physical body. Patients may need the services of counselors, psychologists and psychiatrists to treat the mind.
Equipment and Pharmaceuticals
Modifiers are essential if more than one medical provider is involved and can qualify for additional payment. If it’s necessary to obtain lab work, an x-ray, MRI or similar diagnostic services, chances are the patient will be sent to another provider or facility. Equipment owned and maintained by another entity can be billed using modifiers.
Unbundling Advantages
Procedures that require extra skill, effort and time may qualify for additional reimbursement. Medical billing staff can billed specific services separately through the application of the appropriate codes, edits and modifiers. Practitioners may find that they must perform a second procedure while conducting another. Sometimes the two can be linked, but not if the second procedure is essential to the first.
Modifiers and Edits
Sometimes the difference in reimbursement is as simple as adding the correct modifiers to explain the full extent of the clinician’s services.
For instance, clinicians who make a simple diagnosis of a head fracture will receive much less in reimbursements than a practitioner that enters a diagnosis of a closed head fracture with contusions and lacerations. Each diagnosis is correct, but one provides greater detail and modifiers, allowing billers to enter that information in a way that generates a larger reimbursement.
Same Day and Multiple Treatments
Patients no longer rely on a single healthcare provider for all their needs. When a client sees multiple clinicians on the same day, modifiers are sometimes necessary to indicate each practitioner provided different services
Modifiers indicate a change or alteration in how a procedure or service was delivered. When use of modifiers is justified, it can mean a difference in hundreds and even thousands of dollars each year in additional revenues. They must be utilized judiciously. If not, it can result in paybacks and even legal action.
Supplies, Consultation and Time-Based Coding
A bandage may seem like a small concern, but some clinicians are depriving themselves of income by not including medication and supplies that are dispensed in the office.
The same is true when practitioners provide patients with counseling about medications, treatment options, and coordination of care that accounts for 50 percent or more of the patient encounter.
A complete accounting for the time spent must be documented to prove the service was necessary
One of the largest concerns of payers is fraud and inflated claims. They’re job is to find ways not to pay claims, or as little as possible, which often leads to underpayment for clinicians. With justified use of modifiers and edits, unbundling and hour-based billing, billers can legitimately stimulate significant cash flow for any practice.
