Audit based reimbursement recovery

 

This issue is likely to come up much later in the Implementation process. During the transition period the documentation requirements are increased so therefore it is inherent there is an increased risk of audit failure. Well what does this mean for you, well what it means is you may have been paid on a claim after the payers audit process, they may request the payment back. Why would this happen you may ask, well the main reason is the pa...yers are learning just as you are so that means they are constantly adjusting and also readjusting how they require claims to be submitted to them. You may also feel that this is nothing new payers do this all the time, well you are right and wrong on your response. You are correct in stating that payers do this all the time but this is part you may have not considered in your response. Say for instance the claims that they are requesting a refund on were paid out over 3 months ago, well because your office has assumed you are filing that claim correctly due to payments being made. Now you have a history in the office of assuming you were correct on how these code was documented, submitted, so you must not only start forward filing this code in a new manner but you must first alert the staff this affects, also it is necessary to add this information to your office library. On top of that the funds possibly will be taken out of a reimbursement check you were expecting which could possibly cause a hardship.

 

 

Did you know Facts About ICD-10 Implementation

Did you know when Canada rolled out ICD-10 ,they actually provided coding education in a three phase plan!

Phase 1  consisted of a self-learning package that was supplied to individuals and required approximately 21 hours to complete!

Phase 2 was a two day workshop, that was extremely hands on to the attendees!

Phase 3 consisted of another self learning package of case studies that was provided!

The entire education package consisted of coding software, NO CODE Books involved.  They reported the learning curve averaged around four to six months. No one found that ICD-10 anymore or less difficult to learn than ICD-9!!! (Prophet 2002)

No Exact Match

 

 

When coding Hematuria in ICD-9-CM 599.7 there is only one code but when this code is mapped to ICD-10-CM there are actually four codes that link to this code. Three of the four are more specific. Now if we look at this from a reimbursement standpoint. Your practice decides to use the same superbill after Implementation begins and this code is used........don't you think the Payers will be identifying those codes they know have been expanded more specifically. If you are not prepared and you have not acknowledged this change, your practice will have serious reimbursement issues for things such as this. Find out what diagnosis codes you are using NOW! Identify the changes so your office will thrive instead of fail.....it's really just that simple....

 

 

 



ICD-10 Implementation tip for Front Office Staff

ICD-10 Implementation tip for Front Office Staff

Have you ever considered a customized superbill? What do I mean by customized? I mean are you really using all the codes that currently exist on your superbill. Think of it this way, when the end of  the month reports are run to close out the billing cycle, there is usually an option to run a diagnosis report. Why not create a superbill from the codes you actually use based off of your coding history that your practice actually generated.

Doc You Meant this but documented that!

 

 

 

 

Why is it so important that doctors learn ICD-10?  There are many reasons physicians should be versed in ICD-10, but the main reason is specificity. Plus the level of specificity that exist in ICD-10 does not exist in ICD-9.

 

Some  of the differences that exist in the higher level of specificity is detailed involving disease, actual causes of accidents or illness and different stages of healing, laterality, etc. 

 

So what happens if the  physician does not want to learn, continue to document in the same manner and leave it up to the coding staff to interpret your documentation. This is a recipe for disaster!!!

1.      The coder will need more information to correctly code the claim, therefore medical records will back up in your office waiting on the proper documentation.

2.      This will slow down productivity

3.      Incorrect documentation will have negative effects on patient care.

4.      If payers request documentation in a claims audit and it is incorrect it will cause decrease in reimbursement or possibly no reimbursement at all.

5.      When the claims/billing process gets delayed time will be loss as well as reimbursement. As it is now the is not “enough time” in the day of a busy medical practice.