To Improve Revenue, Cross-train Billers and Coders
It’s no surprise, probably, that in successful practices billing and coding departments are adequately cross-trained. A biller, for example, cannot effectively manage denials without a working knowledge of the coding guidelines. Understanding bundling issues and having knowledge of proper documentation requirements are essential to ensure billing compliance. Communication is crucial between coders and billers to underwrite a healthy revenue cycle. Routine, consistent meetings facilitate the communication process.
Avoid this scenario: Chris works in the coding department. Dr. Fine provided services for long-time patient A. His documentation indicated that he did Level 4 Evaluation and Management (E/M) service along with a procedure. Chris coded the 99214 with a modifier 25 and then the procedure. The claim was submitted. Beth works in the billing department. When the payment came back on Patient A, the E/M was denied. Beth wrote off the office visit without asking anyone.
What happened? For some reason the carrier dropped the modifier when the claim was entered into the system. If Beth had communicated with Chris she would have understood that it was not bundled and that the appropriate modifier was used. A follow-up call to the insurance carrier questioning the denial would have paid this claim.
Billing and coding staff need to know what lays inside your practice contracts to assure services are coded correctly and that payer-specific guidelines are being followed. Contracts contain certain terms and guidelines that must be followed and knowing the intimate details of each and every contract allows for a well prepared team. The job functions both must have a solid understanding of federal and state requirements and applicable prompt payment laws.