|Are you ready for ICD-10? Are your ICD-9 and CPT codes up to date and valid? Do you know which deductible-free preventative service codes to use with which insurance? Do you know when & when not to bill administrative fees? ...if not, you're losing money!
|PROPER CODING IS THE ONLY WAY TO BE ASSURED THAT YOUR PRACTICE IS BEING REIMBURSED AT THE BEST LEVEL POSSIBLE!
|There are two problems that arise from inaccurate or inappropriate use of procedure codes. First, payment may be delayed for many months, or denied completely. Secondly, the payer may "down code" the procedure at their discretion. Let's examine each of these situations in greater detail.
Delayed or Denied Payments:
Insurance companies make their money by holding on to your money as long as possible. If you submit a claim that has an inaccurate or invalid procedure code, your claim is either rejected, or, more often than not, placed into "review" (or holding pattern) until the insurance company feels like sending you the rejection notice. This causes both a substantial reduction in payment amounts and increase in accounts receivables.
This is a method of minimizing reimbursement to the provider. If you submit a procedure code that is invalid or inaccurate, the claims processor will use the description submitted to identify the series of codes that could possibly represent that procedure. They then take the code that would have the lowest reimbursement amount and submit that code on your behalf for payment. To make matters worse, in many cases they simply pay you at a substantially reduced rate without advising you that the code you are using is invalid or inaccurate.
The Most Important....
There are only three ways in which a health care provider can increase their net revenues. First, is to reduce their costs (expenses), which is the most difficult process of all. Second, is to increase their fees. For those practices not using an expert fee analysis system, this is a very uncertain process. Finally, insuring that the procedure codes that are used for billing are accurate and appropriate is the least expensive and in many cases, the most important.
If only 10% of your codes are inaccurate, you're losing 10% of your cash flow or at best you're being under paid for your services...and those payments are usually delayed!
Total Codes ...........................................................200
10% Inaccurate ....................................................20
EACH USED ONCE PER WEEK FOR
1 YEAR 20 x 50wks. = 1000
1000 X $50 each = $50,000
Possible loss to your bottom line!