Healthcare Practice Management

Medical Coding and Its Trends

by Nitin Chhoda PT, DPT | Jul 25, 2016 | Electronic Medical Records, Medical Billing, Physical Therapy Billing, Physical Therapy Documentation

Medical coding can be done by a skilled professional or by a trained physical therapy billing staff. It is important that who ever is assigned this task is knowledgeable and detail oriented because it affects the billing and revenue cycle for the practice.

Nitin Chhoda shares the latest trends in medical coding and the role of ICD-10 codes to the medical practices.

Incorrect medical coding costs small practices thousands in revenues each year. Medical coding can be a tricky process and requires the expertise of a trained professional, even with an EMR.

Physical therapy billing software will significantly reduce the number of errors and denials, but with upcoming changes in billing codes, clinic owners may want to consider hiring a certified medical coder.

Medical Coding and Billing

Medical coding is a complex and demanding environment requiring someone with special knowledge and expertise, and who is detail oriented. Some practices combine their billing and coding departments under the guidance of a single person.

A good physical therapy documentation system will include billing and coding functionalities that makes a coder’s job easier, but then clinicians must decide if they’re going to hire a certified medical coder or train one themselves.

Even with a top of the line EMR, nothing can replace the expertise that comes with an experienced and certified medical coder. They undergo extensive education and training, build upon their expertise with on-going re-certification courses, and are fully able to navigate changes and updates in the coding system as they occur.

They command more money for their medical coding services, but trying to train a new coder is time consuming and can cost the practice thousands of dollars while they learn.

The Coding Process

The introduction of EMRs adds another level of difficulty to the billing and medical coding process.

An EMR greatly facilitates the job of a professional coder, allowing them to maintain a constant rate of concurrent billing and coding procedures, reducing the ebb and flow of payments that can severely interrupt a practice’s financial health.

A factor that will radically affect the billing and medical coding process is the switch from ICD-9 to ICD-10 codes in October 2013 that will introduce 100,000 new codes into the existing system of 13,600.

medical coding trends Correct coding is difficult enough – the on-going educational requirements for professional coders will make it easy for them to handle the many changes and updates.

The medical coding changes will affect every medical provider in the country and represents the first comprehensive update since 1977.

The coding changes take into account new diseases that have been discovered, a better understanding of old ailments, new medications and vaccines, and the effectiveness of those medications in treatment.

With mutating viruses and diseases that can be communicated among species, the coding change is long overdue. Global travel and journeys to under-developed countries sets the perfect stage for pandemics.

Switching to ICD-10 Codes

The switch to ICD-10 codes will help all practices provide medical coding that more accurately reflect treatments and procedures. The result is better patient care, quicker reimbursements and fewer denials.

The future is bright for professional medical coders. Their extensive medical coding training is a distinct advantage for practice owners who benefit from their expertise. Better medical coding means better and faster reimbursements, fewer denials, mistakes and errors, and issues can be dealt with quickly and efficiently. EMRs will help medical coders accomplish those goals in an expeditious manner.

EMRs will soon be a fact for every physical therapy practice. Clinic owners who implement an EMR system with correct medical coding will be ahead of the game when the coding changes take effect. Professional coders will play a major role in ensuring that clinicians are compensated for their time and services.

Healthcare Management and Medical Billing Relationship

by Nitin Chhoda PT, DPT | Jan 4, 2016 | Healthcare Practice Management, Physical Therapy Documentation, Physical Therapy Management

Medical billing and healthcare management are interconnected. The success of the practice relies on these two factors having a good relationship.

Nitin Chhoda explains the correlation between billing and management, and the role it plays in a successful healthcare practice so that the owner will value its importance and avoid recklessness.

Therapists walk a thin line when reconciling the healthcare management of their patients and medical billing.

The process of accurately coding and billing of healthcare practice management can sometimes be at odds with the client’s welfare and their insurance coverage.

Therapists are often dealing with a narrow description of a complicated problem and it’s essential to provide the exact billing codes that describe the diagnosis, symptoms and corrective measures that were taken.

Patients can differ widely in their responses to treatment, making it imperative that therapists provide in-depth documentation to support their actions and conclusions.

Accurate physical therapy billing ensures clients to receive the best possible care and the clinic to reimburse at the highest available level for the services provided.

Healthcare Management and Billing

Billing and healthcare management is a closely interwoven process and it’s the responsibility of clinicians to educate themselves on the intricacies of the two. The result is better billing and coding, expedited reimbursement claims, and staff members that aren’t overwhelmed.

Next to treating patients, billing is the most important position in a practice. A clinic’s profitability rides on the billing professional submitting claims in a timely manner, conducting follow-ups and ensuring payments are received.

Physical therapy billing is complicated and time consuming, and smaller practices often have a designated biller that has a variety of additional tasks.

The day-to-day workflow doesn’t remain the same and it’s easy for billers to get behind without the appropriate healthcare management support and sufficient time to perform their responsibilities.

An EMR facilitates the process, allowing billers to submit claims quickly, efficiently, and with a lower denial rate.

Billing With EMR

EMRs provide clinic owners with the tools to track reimbursement claims, monitor denials, and identify potential and existing problems. On average, claims are denied approximately 50 percent of the time.

This is due to a variety of factors, from incorrect coding to improperly submitted claims. The burgeoning number of healthcare claims and limitations on services has been the impetus for insurers to scrutinize reimbursements more closely than ever.

Therapists with an EMR for healthcare management can utilize its many capabilities to identify denial rates, ascertain why claims was rejected and discover any patterns that might exist.

Problems may lie with incorrect coding, inefficient healthcare management or time restrictions placed on the biller. Once the cause has been determined, clinicians can work toward a solution that better utilizes the biller’s time.

Revenue Loss Factors

Another factor in revenue loss is the number of old and unpaid accounts the practice is carrying. One of a biller’s priorities is to track payments and ensure they’re deposited in the clinic’s account. Billers must review accounts on a regular basis to ensure payments have been made and make inquiries into their status if needed. Billing and healthcare management requires an individual who is detail oriented, with an agile mind and specialized knowledge.

The financial health of a physical therapy practice hinges on the efforts of its coding and billing expert. A large part of effective healthcare management is ensuring the biller has the time and support needed to maintain a steady cash to the clinic.

Ensuring the individual has superior training and sufficient time to perform the necessary and sometimes redundant tasks of billing will boost the clinic’s revenues and allow clinicians to pursue additional streams of revenue.

Medical Billing Company: How It Works

by Nitin Chhoda PT, DPT | Nov 2, 2015 | Medical Billing, Physical Therapy Billing, Physical Therapy Documentation

In this article, Nitin Chhoda describes the role of a medical billing company and how it can help a private practice.

There are some important points to consider when deciding about the company you want to work with, whether to outsource and hire a medical billing company, or train in-house personnel.

Selecting a medical billing company is a major decision and one that must be considered carefully.

Some practitioners choose to handle their billing needs on-site through their EMR, while others simply turn that aspect of their business over to a company that specializes in billing, coding, recovery and collections.

Therapists that choose that path should approach the process in much the same way they would to hire an accountant or financial planner.

The Role of Medical Billing

Medical billing is a highly specialized field and clinic owners should seek a medical billing company that employs certified medical billers that have the education and training to understand the more than 120,000 new codes involved when ICD-10 is implemented.

Insurance companies have a wide variety of requirements and restrictions, and the firm’s medical billers should have a working knowledge of them all. Clinicians should also seek a medical billing company that treats their money as if it was their own and has a proven history.

Don’t be afraid to ask for references and proof of recovery percentages, along with the average turnaround time on reimbursements and their annual write-off rates. The medical billing firm must meet and maintain HIPAA standards, work to recover the maximum amount of revenue for the clinic, and provide regular reports on the financial state of the practice.

For many physical therapists, outsourcing their medical billing needs represents considerable savings for the practice. In-house medical billing may require hiring additional staff to handle the complicated and time-intensive process competently and efficiently.

It can also require significant upgrades to the practice’s current hardware and software systems. Smaller practices may benefit most from outsourcing their billing department and it may present the most cost effective solution.The 21^st century practice doesn’t rely on paper records and neither should the clinic’s medical billing company.

Medical Billing Companies

Today’s billing companies offer a variety of services that includes many of the capabilities available with an EMR, encompassing patient scheduling, client reminders, verification of insurance coverage and a 24/7 call center. They also provide therapists with information to track demographic groups, cancellations, referrals, no shows and new patients.

Billing, coding and collections are processes that continue to become more complex.

Hiring a medical billing company relieves therapists of a time consuming task, while providing clinicians with additional time to focus on patients and their care and an improved cash flow for the clinic.

Billing firms have the financial resources to hire the most experienced and knowledgeable staff, and purchase the sophisticated software and hardware systems.

A facet of the medical billing company that many therapists overlook is the quality of the customer care that’s provided. The medical billing company will often be required to deal directly with the clinic’s clients and will represent the “face” of the practice.

Customer Service Standards

It’s imperative that the medical billing company adhere to the highest customer service standards and represent the clinic appropriately.

Ultimately, practice owners must decide if the cost of outsourcing their billing and collection needs outweighs the expenditures of maintaining an in-house billing department. Therapists with an in-house system should examine their practice to ascertain the efficiency of the clinic’s system. If costs are high and collections are low, hiring a medical billing company may be in the practice’s best interests.

How to Verify if Your Software is ICD-10 Ready

by Nitin Chhoda PT, DPT | Oct 12, 2015 | ICD 10, Medical Billing, Physical Therapy Billing, Physical Therapy Documentation, Physical Therapy Software

The big day for the ICD-10 transition is just around the corner. Practices should have been using their time to train, install hardware and test their software for compatibility with other entities with which they communicate. However, despite the best laid plans and intentions, clinicians may not be as ready as they think. Software systems are a prime consideration and there are steps that practitioners can take to ensure they’re ready when Oct. 1, 2014 arrives.

EMRs

There are dozens of EMRs available. They have multiple features, but clinicians are often required to pay extra for access to updates and other items that should be included automatically. Practitioners will want to ensure they have an EMR capable of handling the new codes and that they have the latest version available installed.

EMRs must have sufficient security measures for HIPAA compliance to safeguard patient information. Consult with vendors to verify that the EMR is HIPAA compliant, code upgrades are covered in any contracts, and if training will be included.

Crosswalks

A crosswalk offers a means of translating ICD-9 codes to the new ICD-10 version. It’s essential that any software include those crosswalks for translation, especially in the early months of the transition. If the EMR doesn’t support crosswalks, clinicians may need to invest in a program to assist with coding tasks.

GEMs

General Equivalence Mapping isn’t designed for long-term use, but it does provide a valuable resource. It’s a tool that can be used to assist in locating the correct code options and help staff become more fluent and comfortable with the new code selections.

Side-By-Side Coding

Until everyone in the practice is familiar with the new coding system, a side-by-side coding feature will prove very helpful. It will reduce staff frustration and help everyone rest easy knowing they’ve entered the correct diagnosis codes.

A system that allows clinicians and staff to incorporate the new coding into their everyday duties will help everyone become familiar with the new codes before the deadline. They can also begin using the new codes prior to the implementation date with entities that are ready.

Billing

It’s critical that in-house or contracted billing services are prepared for ICD-10. They must be compliant with the new HIPAA transaction standards for transmitting data electronically. Be prepared for a reduction in productivity, even with superior billers and coders.

Testing

Testing should include the ability to submit claims and insurance eligibility. The only way to ensure if a practice’s software is ready for the ICD-10 transition is to conduct exhaustive testing in those areas – then test some more. If any glitches or issues do exist, the more the system is used the more likely they will be to become apparent. It’s also important that inter-office systems can communicate with each other.

The software that transmitted a claim perfectly today has the potential not to work smoothly tomorrow. Continued testing is the only way to ensure that problems are identified and addressed prior to the deadline. If for some reason an issue can’t be fixed by implementation day, be sure to have a contingency plan. Relationships with new vendors may have to be established, so be prepared.

Significant coding changes will take place with implementation, but if the practice’s software can’t communicate successfully with insurance companies and clearinghouses to submit claims, they’re of no use and will cost clinics dearly in revenues. Implementation is more than just a coding change. It affects every department. Ensuring the clinic’s software is working correctly will make the transition easier while maintaining revenue levels.

Almost everyone in the medical profession anticipate a loss of income with the implementation of ICD-10. However, some healthcare management and technology firms have postulated that the switch to ICD-10 will present practitioners with opportunities to increase revenues, as it will be easier to document co-morbidities. They also note that the key to increased revenues depends on greater documentation accuracy, one of the stated goals of ICD-implementation.

The Impact of ICD-10 on Billing Staff

by Nitin Chhoda PT, DPT | Oct 5, 2015 | Electronic Medical Records, Healthcare Practice Management, ICD 10, Medical Billing

One of the areas that will be most impacted by the switch to ICD-10 will be the billing department. The ability of billing and coding staff to keep up with the increased coding requirements will have a direct impact on the continued flow of revenues to practices. Staff will need sufficient training in the new codes and even then, it may be necessary to engage additional personnel to address back logs.

After the deadline, any claims that aren’t submitted using ICD-10 will automatically be denied. Coding and billing staff will need the highest level of training available. People learn by doing and whenever possible, it’s a good idea to start using dual coding.

Practitioners that have their billing done by a professional agency will need to consult with the company to ensure the firm is prepared and revenues won’t be disrupted. Part of biller/coder readiness is ensuring that they and the software used is compliant with the strict HIPAA standards governing the electronic transmission of patient data.

Billers and coders may also need a refresher course in anatomy and physiology. The increased specificity of ICD-10 will require more in-depth coding. Billers/coders will find themselves using more specific terms than they’re normally accustomed. Next to the clinician, billers/coders are the most important link in the revenue chain. They must be ready for the transition or revenues will falter.,

Some interruption in the revenue flow will be inevitable. By its very composition, the new alpha-numeric coding system requires billers/coders to switch between a numeric pad and a keyboard, which will result in a slowing of coding claims. Super bills may no longer be a feasible option, requiring billers and coders to learn new forms and formats.

There are bound to be claims that are rejected in error due to the new coding. Claims will require resubmission and coders/billers will find themselves investing a significant amount of time communicating with clearinghouses and payers to determine why claims were denied. No matter how well trained the biller/coder is, those type of instances will slow down the submission and collection management process.

Errors in documentation and rejected claims will result in many patients receiving bills they don’t deserve. While it doesn’t directly affect billers/coders, it will have an impact on practices. Clinicians will see an increase in calls from panicked patients, requiring time and a cool head to explain and sooth clients.

Clinicians must adhere to coding guidelines if billers are to submit accurate claims. Practitioners can’t code for a suspected or probable diagnosis; items that would appear in notes must now be coded; coding should be done at the highest level possible; and a focus should be on medical necessity.

Clinicians and billers/coders have always had a partnership in terms of revenues and that relationship will be even more important as ICD-10 goes into effect. The billing department should be encouraged to seek verification and understanding of any item for which they’re unsure and clinicians should make time for this.

No one can hide from ICD-10. How each team member responds to its challenges will define the ultimate success of the practice and revenue flow.

The Funniest ICD-10 Codes

by Nitin Chhoda PT, DPT | Oct 1, 2015 | Electronic Medical Records, Healthcare Practice Management, ICD 10, Medical Billing

Patients can be struck by numerous objects leading to pain, disability, physical therapy, and perhaps embarrassment, if the new
ICD-10 codes an accurate indicator. Some of the codes seem nonsensical or unlikely. The fact that the codes exist amply demonstrate that these incidences have occurred – and multiple times in some cases.

There’s an extensive array of items that can be thrown, tossed and dropped that will cause injury. Most will lead to a visit to the ER or the physical therapist. Clinicians will definitely want to be ready for patients who have been hit by rowdy wildlife, from dive bombing macaws (W61.12XA) to head butting cows (W55.22XA) who may object to being milked.

If Grandma gets hit by a reindeer, code it as a V06.00xA, but for individuals who get thrown from a sleigh pulled by reindeer, that’s a code V80.929A. People interacting with churlish chickens with a propensity for throwing themselves at bipeds will code as a W6a.32XA. The codes make no differentiation between rubber chickens and real chickens, but there are codes for multiple encounters.

Land animals aren’t the exclusive cause of injuries. For the luckless patients who experience injury at the fins of water-dwelling creatures, it may feel like a script for a disaster movie. Clinicians will find coding options for clients with first and subsequent encounters with outraged orcas (W56.22xA), those who have been exposed to turtles (W59.29) and not-so-playful dolphins (W56.02XA).

Some individuals are just unable to multi-task while doing even the simplest things. Distracted talking and texting has led to multiple mishaps that practitioners will be coding for and may lead to some strange encounters with payers. There’s a code for people running into a lamppost (subsequent encounter, W22.02XD) and when walking the family canine (W54.1XXA).

Mankind is adept at conceiving new ways of having fun and doing it in the most dangerous venues possible. Bungee jumping (Y93.34), parasailing (Y93.19) and even playing a percussion instrument (Y93.32) or Y93.J4 for lips stuck to an instrument, can lead to unwanted conclusions. A friendly game of ultimate Frisbee (Y93.74) is cited as the reason for pulled muscles, broken bones and even whiplash.

Even fun with imaginary and inanimate creatures can be hazardous. Individuals who sustain an injury by running through a snowman, (thereby committing snowman homicide or possibly a hit and run) will code as Y02.8xxA. For those who are confused about where to put the carrot during a snowman build and insert it in their own ear, use code T16.2xxA. On the dark side, those bitten by a vampire (superficial bite of other specified part of neck, initial encounter), that’s a code S10.87xA.

When hair causes constriction (initial encounter) clinicians will turn to code W49.01XA and E928.4 for an external hair constriction. For a non-scarring hair loss, there’s code L65.9. There’s no telling when a bad hair day will result in serious injury.

Even the very air is fraught with potential danger. For clients who discover they have an air leak, use code J93.82. Patients may be injured through falling spacecraft (V95.49XA). When clients displace their balloon, code it as a T82.523S, but for victims of a falling alligator, that’s code W5803XA.

ICD-10 codes reflect real incidents and complaints, but the ways in which they’re worded often make them fodder for fun. The primary points clinicians need to remember is that they need to code to the highest level possible and as accurately as possible – even if it results in long conversations with payers who have disbelieving minds. Perhaps they could code for a therapeutic massage.