Always Code the Most Specific Diagnosis

Inaccurate or non-specific diagnosis coding can adversely affect your reimbursement of medical claims. Many categories of the ICD-9 contain codes that represent the non-specified site of a certain neoplasm. The are typically indicated with a “9” as the last digit of the code.

Even though all of these codes are viable, accepted diagnoses, many payers, especially Medicare, highly encourage the use of the more “site specific” codes. Failure to be specific can in some instances cause Medical Necessity denials as the non-specific codes may not be listed as acceptable in the payers' Medical Policies. Also, if audited, a discrepancy between the treating diagnosis in the medical chart and the diagnosis submitted on a claim, could cause payment reversals and money due back to the payer.

In all medical specialties, the patient medical record should dictate what services are billed and the diagnoses used.

One specialty example is Radiation Oncology. The prescriptions for Radiation Therapy Treatment Courses are very site specific, so this information is one of the most helpful tools in proper diagnosis coding when used in conjunction with patient data the medical staff has entered into the medical record.

In any specialty, but quite frequently in Radiation Oncology, a patient can have numerous diagnoses that require treatment. In these instances, it is especially important to indicate the proper diagnosis priority on your services. The priority one diagnosis should always be the current treating diagnosis for the service you are billing.

Another frequent situation in Radiation Oncology billing arises when treating a patient for metastatic disease. The metastatic treatment site will be listed as the priority one diagnosis with the primary original site diagnosis listed as the second.

Other specialties would follow a similar scenario if they were treating a complication diagnosis, billed as priority one, from an initial diagnosis, billed as priority two.

A medical billing system with comprehensive ICD -9 and ICD-10 code files, such as Iridium Suite can assist your office in accurately billing the most specific diagnoses for the patients in your practice.

Electronic Health Record (EHR) and Medical Billing Systems

An EHR must not only record your patient data electronically, but should be certified for meaningful use by CMS. Once you select a certified system, this gives you the potential to earn financial incentives from CMS by providing the required proof of meaningful use.

Integrating multiple systems can enhance your work environment and improve efficiency. Your medical billing system should be able to directly import medical data such as patient demographics from your EHR. This type of integration will eliminate the need for re-entry of patient data into the billing system by office staff.

Iridium Suite medical billing software now comes with the Connectivity Clearinghouse enabling connections to multiple EHR systems. You can connect to your EHR as often as your office work flow dictates. With accurate and complete data entry in your EHR, you are able to bring in all the necessary information to bill and file your patient claims. 

The Connectivity Clearinghouse can use multiple protocols such as: LLP, HTTPS, and SFTP. It can also be extended to use multiple data formats such as: multiple versions of HL7, any well formed XML and delimited text.

The versatility of the Connectivity Clearinghouse in Iridium Suite medical billing software provides the foundation to integrate with your existing Electronic Health Record, saving your practice time and money.

Optimize Use of Electronic Data Interchange In Medical Billing

Electronic data interchange (EDI) is the structured transmission of data between organizations by electronic means. It is used to transfer electronic documents or business data from one computer system to another computer system, i.e. from a medical practice to an insurance payer.

                                                

Medical billing software should utilize the following three common EDI functions: submission of Electronic Claims, utilization of Real Time Eligibility (RTE) and receipt of Electronic Remittance Advices (ERA's). Lets look at each one of these further.

• Electronic Claims replace the standard HCFA 1500 paper claim forms that are printed and mailed to the payer. The claims are batched in the medical billing software and then transmitted in an electronic format directly to the payer or to a clearinghouse. If a clearinghouse is used, they serve as the middle man for all the EDI transactions. Unlike with paper claims where you have no way to verify receipt by the payer, electronic claims can be tracked through each stage of the process, from receipt by the clearinghouse to the acknowledgement and acceptance by the payer. Additionally, electronic claims are pre-screened for certain errors with notices being sent back to the medical practice within days for quick correction and resubmittal. Due to their formatting, electronic claims are much more quickly processed by the payer, reducing the wait for reimbursement in some cases from weeks to days.
• The Real Time Eligibility function in the medical billing software allows the medical practice to verify patient insurance coverage before services are rendered. The details provided in the RTE response also confirm or provide other valuable data such as, patient address, health insurance identification number and group number, and effective dates of coverage. All of this information eliminates denials for lack of coverage and provides great assistance in submitting clean claims that will be processed quickly.
• Electronic Remittance Advices are the electronic equivalent of a paper Explanation of Benefits (EOB). The medical billing software imports the ERA from the payer or clearinghouse and often can adjudicate the payments automatically in the indicated patient's accounts. Amounts that are designated Contractual Obligations are written off, patient responsibilities such as co-pays and deductibles are allocated to the patient balance, and other open balances are applied to any appropriate additional payers. Even information regarding denials is attached to the designated services with complete details allowing medical office staff to research and choose the best action in order to resolve the denial with the payer.

If your medical billing software is not utilizing all of these functions, it may be time to look for a better solution, Iridium Suite by Medical Business Systems.

                                        

                                            

PQRI- Streamline Your Process

PQRI is the Physician Quality Reporting Initiative created by the federal government.  As with most government programs, especially those offering financial incentives, filing PQRI can be difficult to navigate.
You could spend hours combing through the 318 Reporting Measures for 2012 to figure out which ones apply to your medical practice.  Then additional hours completing all the questionnaires for the applicable patients.  Don't forget to file the measure(s) code(s)with the qualifying code on your Insurance claim forms or it will all be for nothing.
Even though none of this sounds like fun, an advanced medical billing software like Iridium Suite can take most of the work out of PQRI.

Five Ways to Improve Reimbursement of Medical Claims

Often the handling of accounts receivable is considered distasteful, something that can be ignored or should be handled by somebody else.  Too often the calls don’t get made to insurance companies, the appeals don’t go out, or the resolution of denials is put off.  Even though it may be difficult to find time to perform these tasks, they are an integral part of every successful medical practice.
It is crucial to have a plan for working your accounts receivables.  Follow these suggetions below to get your cash flow going:                                           

• Setting aside the time and assigning the accounts receivable task to one person is the most logical option.  This assures a focused attempt to resolve problems and may reveal erroneous patterns in billing that are missed by several people handling the receivables ‘on the fly’ or ‘when they have time’.
• Most insurance companies have made information quickly available online through their secure websites.  Often an EOB or check that has been missed may be found online and entered in the accounting software without picking up the phone.  The website can also offer more detailed information regarding claim denials.  Additionally many insurance websites offer direct email to quickly access customer service with any questions.
• Each insurance company has an appeal process that must be adhered to in order to get the attention directed to your claim. Keep an appeal file with details (also available on websites) so that the information is quickly available. When an appeal letter is written, keep a copy on the computer and use it to easily change only the patient information and date, thereby saving additional time and keeping the format needed by the insurance company.
• If there is no other way around making the occasional phone call to an insurance company, they often have an IVR (Instant Voice Response) telephone number where you can retrieve all the information needed regarding claims and eligibility. To accomplish this task quickly, make sure all the details are at your fingertips prior to making the call. If you must speak to a ‘live’ person, get as much information as possible at the time of the call to avoid repeat calls.
• Finally, if there is no time to squeeze these tasks into any staff schedules, check into hiring outside personnel that will concentrate on this important job. Make sure they have the communication skills and availability to give feedback when necessary so that recurrent findings or problems can easily transfer back to billers or medical staff. 

Staying involved with accounts receivables is a win-win solution for medical offices, patients and insurance companies. The best medical billing software can help your practice stay organized and maximize claim reimbursement.