Medical Billing And Coding In-House

Medical Billing And Coding In-House

Whether your medical billing and coding should be in-housed or outsourced, there are certain things that are worth considering.  Nitin Chhoda shares the advantages of an in-house medical billing and coding for a small or new private practice.

medical billing and coding in-houseOne of the biggest considerations for many practices is whether or not to conduct the medical billing and coding in-house or to outsource the work.

The question tends to focus on costs, which makes sense.

If your practice can save money by hiring a company to handle the medical billing and coding for you, why hire someone in-house?

But of course, calculating how you are best served is not all that simple. The determination often depends on the size of the office, how many claims need to be filed per day, how many clinicians work at the practice, and the costs of related hardware and software.

And of course, does in-house medical billing and coding improve the rate at which your claims are accepted and paid, or will outsourcing improve collection rates?

Benefits of In-House Billers

The most obvious decision will have to do with the amount of billing that your in-house billers and coders can handle.

In a very small practice, where the receptionist can handle scheduling, medical coding, and medical billing without being overwhelmed, hiring out medical billing and coding is probably unnecessary. And there are a few benefits to having the medical billing and coding professional right there in the office with clinicians.

When you can talk to your medical billing and coding staff member directly, all the details can be accessed at any time about any claim. One downside of an off-site service is that you have less control over and less access to your billing history.

Some services will provide reporting as a scheduled service or on demand. But timing will still be hampered by the fact that the medical billing and coding staff handling your practice probably has a number of practices to worry about. The process becomes less personal.

medical billing and coding needsAnother benefit of in-house medical billing and coding is that the information only has to be communicated once.

In other words, in many ways an outsourced system will require that someone put in a decent amount of work to get the billing accomplished.

In the most efficient scenario, you could simply scan relevant documents and hope they understand what is written.

But outsourcing will not mean that all aspect of medical billing and coding will be handled elsewhere. Someone still needs to be available for communication and transfer of information.

Size Matters When it Comes to Price

As you can imagine, the larger a practice gets, the more efficient an in-house biller can be. If you have a very small office, hiring one or two staff members just to handle medical billing and coding careers will be very expensive. In a private practice, there is a fine line to be drawn between having one staff member to handle everything administrative, and having too much work for a single staff member to handle.

When staff members with lots of responsibilities get overwhelmed, all tasks begin to suffer. And when medical billing and coding suffers, the entire practice is put in jeopardy.

Medical Billing Mistakes to Avoid

Medical Billing Mistakes to Avoid

In this article, Nitin Chhoda reveals the common mistakes in medical billing and coding that can quickly impact the cash flow of a private practice.

Some of the mistakes such as illegible handwriting, use of language and incorrect details can be avoided by using an automated physical therapy documentation system.

medical billing mistakesMedical billing and coding errors, mistakes, oversights and insufficient coding represent the most costly problems that physical therapy practices face, resulting in the loss of thousands of dollars in revenue each year.

The busier the clinic, the more likely it is that the problem will occur. An EMR will help eliminate denials and late payments, but practice owners must make medical billing and coding a priority.

Insurance providers are scrutinizing reimbursement claims more closely than ever before, making it imperative that the person responsible for billing and coding be trained and knowledgeable in the specialized language of the profession and familiar with EMR practices.

Sometimes it’s the simplest codes that create denials and a professional medical billing coder can make a tremendous difference in the revenues collected.

Details

The little things in medical billing and coding can wreak real havoc on revenues and result in denials. Identifying a male client as female, dates that don’t match, using outdated codes and not coding for a multiple diagnosis are just some of the ways therapists slow down their cash flow and generate denials. Illegible handwriting is always a problem and if the writing can’t be read, it can be deemed unbillable. Utilizing an EMR will eliminate such problems.

medical billingLanguage

Coders rely on therapists for the information needed to correctly code claims. The language and terms taught and learned in school aren’t necessarily those used in a real world practice.

It’s important for the therapist to include notes to ensure coders have enough information to bill at the highest acceptable level. Therapists should also impress upon medical billing coders the need to look at the explanation of procedures.

Services

Physical therapists offer a wide range of services and products, but in a busy practice, some may go unnoticed when it’s time for billing. Failure to bill for ancillary services such as, medications and supplies dispensed in the office, along with x-rays and lab work that was performed, are just some of the ways that therapists rob themselves of essential income. Clinicians need to make a conscious effort to ensure that each service, appliance and aid is documented for medical billing purposes.

Documentation

If the service, treatment or procedure isn’t documented, it can’t be billed. Coders can only work with the information provided, even with a technologically advanced EMR. Relying on the coder to “know” that a specific service was provided is pure folly. Document everything in detail and be clear about the type of service offered, including referrals and consultations. It may take a few extra seconds, but the extra time will pay off in greater revenues even in your medical billing.

Up- and down-coding

Medical billing for services at a higher level than documentation supports is embarrassing in the extreme. Many clinicians choose to down-code, hoping to avoid the specter of an audit, and only succeed in cheating themselves of valuable reimbursements.

Insurance Providers

Insurance providers aren’t infallible and it’s up to the practice owner to carefully oversee the explanation of benefits to catch medical billing mistakes when they occur. There’s a tendency to think once the reimbursement claim has been submitted, that’s the end of the process.

In truth, it’s simply the beginning. Insurance companies can lose or misplace claims, or never receive them at all. Therapists who don’t conduct regular audits on the state of their claims stand to lose significant amounts of money.

In the new economy, it’s essential that physical therapists code correctly to ensure they’re reimbursed for their time, services and supplies. Every precaution must be taken to provide clear and concise documentation. The implementation of a correct medical billing EMR will greatly reduce the number of errors, mistakes and denials for the financial health of any clinic.

Medical Billing and Coding – In-House or Outsourced?

Medical Billing and Coding – In-House or Outsourced?

In-house or outsourced medical billing and coding have their own advantages and disadvantages depending on the size and the needs of the physical therapy practice.

Nitin Chhoda elaborates the differences between these two methods, and how to maximize the billing and coding process for your business.

medical billing and codingMedical billing and coding are one of the most important tasks for practice owners to consider.

However, many are unsure whether to maintain a billing and coding department on-site or outsource the entire operation to a specialty firm.

In-House or Outsourced?

Both methods have their own set of advantages, but many therapists are finding they have the same set of tools available in their EMR as those offered by medical and billing companies.

Therapists have always had the option of outsourcing their medical billing and coding tasks, but it’s a major expense that may not be necessary with the implementation of an EMR. Physical therapy documentation software allows clinicians to submit bills electronically themselves, but they may still want to consider hiring a professional coder to work with the EMR.

Outsourcing Options and Benefits

Outsourcing medical billing and coding needs provide practices with a one-stop solution that takes the reimbursement process out of the office and places it in the hands of companies that employ trained coders who handle all the submissions and details. Such firms can verify insurance information and authorizations, reconcile accounts, and provide code checking and analysis services.

medical billing and coding optionsThe same firms can conduct audits to help clinics operate more efficiently and provide training for staff on medical billing and coding-related issues.

They eliminate the need for purchasing and establishing hardware and software infrastructure.

Outsourcing also negates the need to hire a professional coder and the associated expenses of a salary, insurance and benefits.

Coding and billing firms are HIPAA compliant and feature a rapid turnaround time for reimbursements.

They reduce the work associated with billing, providing therapists with more time to see clients. For some clinics, it’s an ideal situation. For smaller practices, it may be an added expense that the clinician simply can’t afford.

In-House EMR Advantages

Therapists using an EMR can send reimbursement claims individually or via batch filing. Therapists must implement an EMR by 2014 and EMRs contain their own medical billing and coding abilities.

It just makes sense to utilize the technology to handle a task that affects the financial stability and security of a practice. Since therapists must implement an EMR anyway, there’s no good financial reason to spend additional funds contracting with an outside firm.

An EMR provides therapists with all the services offered by a medical billing and coding firm, along with updated ICD-10 coding changes. Electronic submissions allow therapists to collect their fees quicker and they can be automatically deposited in the clinic’s account. EMRs are HIPAA compliant for security and safety, and enables users to conduct audits on the state of the practice.

EMRs offer the ability to verify client insurance information and eligibility, collect one-time and recurring payments from patients, and send balance reminders to clients in the form of email, text and voice messages.Clinicians can conduct medical billing and coding tasks themselves, or hire a certified professional versed in the intricacies of the EMR, new codes and EMR documentation systems.

Balance Cost and Convenience

In the final examination, all therapists must balance cost and convenience. Outsourcing to a medical billing and coding firm eliminates the need for an on-site coder and facilitates a quick turnaround on reimbursements, but the cost may be prohibitive.

EMRs are designed with the ability to manage patient accounts, submit claims electronically, and collect from patients online. Therapists must implement an EMR by 2014 and many are discovering that they don’t need to outsource medical billing and coding when they can accomplish the same tasks with their EMR.

The Impact of ICD-10 on Clinical Staff

The Impact of ICD-10 on Clinical Staff

The type of ICD-10 training needed by clinical staff will depend upon a variety of factors. An advanced level of ICD-10 training will be required for any clinical staff that works directly with patients to provide medical care.

The role of clinical staff has changed over the years. Nurses, therapists and nurse practitioners are now on the forefront of patient care. Many work directly with super bills that may be eliminated and new methods must be learned.

New provisions in HIPAA compliance affects the dissemination of protected patient information. Any clinical staff in a practice that is involved with providing patient care or access to client health information will need a thorough understanding of ICD-10 coding, including staff that provides in-home therapy or care.

Depending upon their level of education, the individual practice, and the laws within the state, clinical staff can conduct exams, make diagnoses, give injections and are authorized to prescribe medications. They can prescribe physical therapy services, make referrals and order testing. These staff members will need specialized training in ICD-10 coding.

Health care coverage is undergoing major changes due to the Affordable Health Care Act. Depending upon the individual practice, clinical staff may be responsible for scheduling referral appointments and obtaining pre-authorizations. Clinical assistants will be affected by changes in health insurance policies and advanced beneficiary notices (ABNs) that will need to updated and reformatted.

One of the responsibilities for non-coding clinical staff will be to educate patients about all of these changes and how they will be affected. Clinical staff may also include technicians for practices that maintain on-site lab and testing facilities. In smaller practices, a single individual may wear many hats and ICD-10 training options must take that into account.

Large, comprehensive practices may encompass case workers, patient advocates and staff that oversee sales of medical products and devices. Clinical personnel in these capacities may need ICD-10 training, but not the intensive level of those who must enter ICD-10 coding. For many non-clinical personnel, the biggest shift with which they may have to adapt is procedural changes.

A byproduct of the Affordable Health Care Act is that patients will have increased access to their health information through patient portals, but it may result in an increased work load for clinical staff. A patient portal allows clients to access test results and other information, but it could result in an influx of calls to which clinical staff must respond.

The patient understanding of what medical personnel told them and subsequent coding may not be an exact terminology match, leading clients to contact the practice for clarification. Any terminology with which patients are unfamiliar or they disagree may result in calls and an additional workload.

Conversely, the greater specificity that coding clinical staff can utilize may be appreciated by older patients. ICD-10 allows clinicians to more accurately describe their level of pain or disability. The in-depth information may result in increased services for chronic conditions and pain management programs.

The bottom line for practitioners is that every member in the practice will need some type of familiarization with ICD-10 coding and/or the procedural changes the transition will engender. A careful analysis must be conducted to identify the level of training and ability each person has to provide effective training for everyone from the front desk and clinical staff to management.

The 10 Step Preparation Blueprint for ICD-10

The 10 Step Preparation Blueprint for ICD-10

The transition to ICD-10 encompasses much more than simply acquiring the codes and using them. It’s an involved process that requires careful planning, organization, funding and training. With the Oct. 14, 2014 implementation date just a few months away, it’s imperative that clinicians have an action plan in place to meet the deadline. Failure to be ready will result in practices being out of compliance and the denial of reimbursements.

Make A Plan

Planning is key for ICD-10 implementation. The plan must include a timeframe for all the changes and training to be completed, along with a review of the regulations and requirements for transition. ICD-10 can’t be put in place piecemeal. Solicit volunteers or appoint a single individual or team that will be in charge of ensuring each planning step is accomplished.

Break It Down

The transition will include several phases, from the installation of software and hardware to staff training and equipment testing. Break the implementation process into smaller bites to make it more manageable.

Discover if there are any steps or measures that must be completed by a certain time. Clinicians should select a single person or a team to oversee each additional phase of the transition. These individuals will be responsible for ensuring training, IT, software, funding and other associated steps are addressed and completed correctly.

High-Level Assessments

No action plan can be launched without knowing what the impact of ICD-10 will be on the practice. Practices are not the same, even within the same field or specialty. ICD-10 will affect documentation, billing and coding, and the practice’s technology, along with staff education, procedures and funding. An in-depth assessment of the practice and staff will identify areas of concern.

Two of the most critical departments are billing/coding and documentation. Constant and continued communication with vendors, payers and clearinghouses must be maintained to determine compatibility during testing phases. This is also a good time to discover any changes in reimbursements that may be coming in the future. Documentation practices will need evaluation to ascertain if they’ll meet ICD-10 coding requirements.

Secure Funding

Implementation is going to be expensive. Funding will need to be secured for a multitude of expenses, many of which may change along the way. There will be costs associated with software upgrades. Practices that opt to maintain their own on-site server will require equipment purchases and advanced security protection.

Until all patient data has been transitioned to the ICD-10 system, clinicians will be utilizing dual coding. The most recent version will be needed in software and printed form. There will be hardware systems to upgrade and software to install. Technical modifications may be required to meet HIPAA standards or meet high-speed data transmission.

Personnel Training

Training staff in the use of ICD-10 and new privacy guidelines is necessary, and clinicians should be prepared for a loss of productivity. A wide array of professional organizations and companies offer training in multiple formats. All staff members won’t require the same amount of education and not all people learn the same way.

Training services offer sessions that incorporate eLearning, interactive exercises, and mobile and smartphone applications, along with classroom education, discussion forums, practice tools and simulations. Some customize the training to the individual. Clinicians should ensure that the training entity maintains an appropriate means of ensuring that each staff member is proficient.

Clinicians should be aware that the ICD-10 transition requires new knowledge, skill sets and procedures. Not every staff member may be able to make the transition successfully. New staff may need to be hired to replace those unable to cope with the changes. Training should begin with coders, clinicians, clinical staff and other staff, in that order. Everyone should be aware of the training schedule.

Internal Testing

Practices should begin internal testing of their new hardware and software systems to address the inevitable problems that come with such a major undertaking. IT professionals will be a common sight in practices as they perform upgrades, test systems and address problems, all of which can result in productivity losses. Be prepared.

External Testing

When internal testing is complete, practices should begin testing their systems with clearinghouses, insurance companies, payers and vendors as soon as possible. Staff should know when testing is scheduled and be prepared for interruptions. Conduct simulations and test runs to ensure communication with critical entities and develop a contingency plan for any potential problems.

HIPAA compliance standards must be met for the secure transmission of data. Clinicians work with a host of pharmacies, labs, hospitals and other physicians and they’ll also need to communicate securely and seamlessly with those entities. This is also the time when clinicians should determine which ICD-9 codes they use most often and map them to the ICD-10 version.

Going Live

Once all system software is working in concert with critical entities, begin dual coding as needed. Create an ongoing plan for determining the source of any errors or problems. Identify any staff members that may need additional training. Additional staff may need to be hired to address back-logs and loss of productivity in the first few months of ICD-10 implementation.

Getting Paid

Coding and billing activities deserve special monitoring to ensure continued productivity. In-house billing/coding departments could require additional personnel to maintain a steady workload. The alpha-numeric composition of ICD-10 coding requires billers/coders to switch between their keyboard and numeric pad. It will take extra time to complete the billing process. Any denied claims will need careful tracking to determine where documentation or coding errors may be occurring.

Auditing The Process

There are sure to be glitches along the way, even after several months of ICD-10 use. Processes and procedures throughout the practice have changed. The new codes should be audited to ensure the latest versions are being employed and communication with essential entities monitored for any undetected problems that may have crept in. Most importantly, monitor reimbursements to ensure that pre-ICD-10 implementation amounts have remained the same.

The ICD-10 changeover will be many things – exciting, expensive and frustrating. Creating an action plan will alleviate many of the potential problems. Appropriate training and education is essential and ongoing monitoring of revenues, procedures and processes will ensure a successful transition.

Unusual Examples of ICD-10 Codes

Unusual Examples of ICD-10 Codes

Clinicians preparing and training for implementation of the ICD-10 code set have encountered some unusual results. In an effort to be more specific, eliminate waste, reduce fraud and save money, the ICD-10 codes are very specific, sometimes to the point of being humorous.

Practitioners can now provide coding that may leave insurance companies wondering about their clients and the activities in which they’ve been engaging. Every clinician remembers a strange or unique situation for which they’ve billed – and the difficulty they had explaining it to the patient’s insurance company. The following are some examples of the unusual and sometimes humorous coding available with ICD-10.

Members of the animal kingdom can be unpredictable, but ICD-10 coding points out just how unanticipated some situations can really be, from fast moving turtles to equine collisions. In the animal category, practitioners will find some interesting injuries to be noted and places where the event took place.

  • W59.22XA – Struck by a turtle
  • W611.2XS – Struck by a macaw, initial encounter
  • S30.867A – Anal insect bite, non-poisonous
  • V80.730A – Animal-rider injured in collision with a trolley
  • Y92.72 – Injury obtained in a chicken coop

All families have problems, but it seems that some clichéd situations are eternal. When families have problems, there’s a code for that.

  • Z63.1 – Problem with in-laws
  • Z62.891 – Sibling rivalry
  • W21.31XS – Struck with footwear
  • Z62.1 – Parental overprotection
  • Z73.4 – Inadequate social skills, not elsewhere classified
  • R46.1 – Bizarre personal appearance
  • G44.82 – Headache associated with sexual activity
  • R45.2 – Unhappiness
  • The arts can be dangerous and that’s amply demonstrated by ICD-10 codes that identify the supposedly safe venues in which to enjoy entertainment, but may not be as protected as individuals might think.
  • Y92.253 – Injured in an opera house
  • Y9250 – Injured at an art gallery
  • Y92.26 – Movie house or cinema
  • Y92.251 – Museum

Work-related accidents and injuries are a common complaint for medical professionals and the new codes reflect such injuries. It would appear that some individuals are at high risk of being injured is some unique ways, and some return for an encore performance.

  • V97.33XD – sucked into a jet engine, subsequent encounter
  • X52 – Prolonged stay in weightless environment
  • V95.41XA – Spacecraft crash injuring occupant
  • Z89.419 – Acquired absence of unspecified great toe

Leisure time activities account for a large portion of injuries. Sports-related injuries top the list, but there are some lesser known activities that can be just as dangerous. When it comes to leisure time activities, clients are presented with multiple opportunities for injuries.

  • V91.07XA – Burn due to water skis on fire
  • Y93.D1 – Stabbed while knitting or crocheting.
  • Y92.146 – Hurt at prison swimming pool
  • T63 – Unspecified event, undetermined intent (to be specific)

Some of the ICD-10 codes bring to mind weird and wacky laws that have outlived their usefulness, but have never been removed from the books. It bears remembering that while some codes were developed to address potential problems and injuries of the future as technology advances, many of the codes currently exist because a particular situation actually happened to someone, somewhere, sometime…