Don’t Make These Common Billing and Coding Mistakes

Don’t Make These Common Billing and Coding Mistakes

Mistakes in the billing and coding process can take many forms, from incorrect ICD coding to ethical violations. In this revealing article, Nitin Chhoda examines the most common errors facing billers and coders, and identifies ways to avoid them.

billing and codingBilling and coding specialists work with protected information every day. Their actions have an impact on their employer, payers and patients. It’s essential that they maintain the highest ethical standards and are cognizant of laws that could inadvertently be broken.

Dishonesty

Billing and coding staff work with facts that are backed up by practitioners with documentation. Never assume and don’t include codes that are only implied.

Appropriate documentation must accompany every claim and support the clinician’s diagnosis and treatment. Neither should codes be unbundled to claim additional reimbursement. Codes should accurately reflect the patient encounter.

The Blame Game

If a mistake is made, accept the blame instead of trying to foist it off on another billing and coding staff member. If a problem exists in the claims process, address the situation with the appropriate individual.

Over Billing

Many practitioners record every action during the patient encounter, but that doesn’t mean every detail is billable. Only claim procedures and treatments that are supported by documentation and don’t second guess the clinician. If doubts or questions exist, clarify with the practitioner.

Unbundling

Some actions are incidental to specific procedures and shouldn’t be billed separately. Learn which procedures can be bundled and which ones can’t to ensure accurate billing and coding.

Ignoring Errors

A mistake can be anything from an omission or incorrect code to a transcription problem. When errors are discovered, they should be brought to the practitioner’s attention. Fix the problem immediately and submit a corrected claim. Ignoring an error can result in payments to which the clinician isn’t entitled and opens the door to fraud.

Overpayments

Even when claims are submitted correctly, errors can occur in billing and coding that result in over payments. The payer should be notified of the mistake immediately. Be prepared to follow the necessary procedures to return the funds. Doing so reinforces the practice as a desirable partner.

Failure to Protect Patients

Clients may be required by their insurance company to only see certain providers within the payer’s network. Failure to do so can result in costs the client can’t pay and no reimbursement for the clinician. Patient coverage and benefits should be verified by billing and coding staff before their visit.

If there’s a problem, the client can be advised of their options prior to treatment.

Authorizations

More payers are demanding pre-authorizations before they pay for services. Failure to obtain the appropriate authorizations or referrals can result in billing and coding claims being denied and loss of payment for the provider.

Patient Confidentiality

The law protects patient information and anyone who discloses personally identifiable data is in violation of HIPAA regulations. Penalties for violations include significant fines and jail time. It’s imperative that all staff members, including those in medical billing and coding, are aware of HIPAA laws and consequences of breaking the patient’s trust.

Unscrupulous Managersbilling and coding staff

Some billing and coding managers aren’t as cognizant of coding rules, procedures and penalties as they should be, and they may even urge those in their charge to ignore or overlook issues.

Don’t be afraid to report such matters to the manger’s superior.

Mistakes are inevitable, but they should be rectified immediately. Precautions should be taken to protect patient information and uphold the highest of ethical standards to protect the integrity of the billing and coding staff, and the practice.

Physical Therapy Management for the New Economy

Physical Therapy Management for the New Economy

Nitin Chhoda shares the status of physical therapy management and practice in today’s economy. Physical therapy management in the new economy represents major changes for therapists, from the treatments provided to monetary reimbursements.

physical therapy managementPresident Obama’s aggressive healthcare reform program has changed physical therapy management in the new economy, the full effects of which are yet to be seen.

The new goals require physical therapists to think less like service providers and more like business owners, focusing on relating not just treating.

New Insights

To assist therapists, Chhoda offered new insights into management issues in the new economy.

“We need great physical therapy management and business systems to empower our clinical skills and retention systems to increase the number of patient visits,” said Chhoda. “Staff members need incentives to perform better and therapists need strategies to build multiple referral systems.”

Physical therapy management services encompass much more than patient care, scheduling, billing and reimbursements. It’s a total plan that maintains the highest patient care standards, builds reputations, and protects the overall profitability of the practice.

EMR Adoption

To insure those goals of physical therapy management services are met, therapists will need to adopt electronic medical records (EMR) technology, identify cost effective treatments and interventions, and help train a superior workforce for the future.

Physical therapy management in the new economy represents major changes for therapists, from the treatments provided to monetary reimbursements.

For many therapists, a large portion of their patients may be those receiving Medicare and Medicaid. Physical therapy management will require affordable access to high-quality care that still provides adequate reimbursements for the practice.

Regulations

physical therapy management new economy

In the new economy, therapists are facing restrictive regulations and payment policies that effectively separate them from the patients that need them the most.

Physical therapists are on the front lines of patient care, working to restore functionality, mobility and quality of life to their clients.

As reimbursements decline, physical therapy management will have to include billing and coding changes, and therapists will need to work to identify treatments that achieve the same effect in a more efficient manner.

Initiating an electronic medical records system will assist therapists manage their practice on a variety of levels. Electronic billing allows faster reimbursement recovery and greater billing flexibility.

Documentation Process

EMRs provide comprehensive documentation at a glance, allowing therapists to begin appropriate treatment quicker. An essential part of future physical therapy management will include increasing referral rates and discovering creative avenues for doing so.

Establishing closer relationships with physician practices and hospitals, and educating them about the benefits of physical therapy will help facilitate that goal. Training an efficient and knowledgeable workforce will insure a superior level of patient care.

Physical therapy management is a multi-faceted endeavor and Chhoda’s new insights provide practice owners with food for thought. Therapists can no longer be satisfied to provide superior treatment. The must identify more effective methods that meet patient needs and enables clinics to remain profitable.