Part B Insider (Multispecialty) Coding Alert

Published on Wed Aug 24, 2005 PDF

5 tips for capturing your rightful reimbursement

Physicians have a habit of forgetting to report all the consults and  follow-up inpatient procedures they deal with during hospital visits. But experts suggest there are ways to get the info you need--and the reimbursement you deserve for those extra hospital-based services.

1. Don't assume your payor won't cover post-operative complications. Medicare won't cover complications during a global period, but most other payors will, says Marcella Bucknam, HIM Coordinator with Clarkson College in Omaha, NE. "I have seen thousands of dollars of services that were legitimately billable and payable for non-Medicare patients," but practices weren't billing them, Bucknam laments.

2. Print out cards that say "Rounds" for the physician to take to the hospital, and he'll be more likely to note if he was pulled aside to perform a consult or minor procedure on a patient, advises Bucknam. It's best if your office printer can handle actual cardstock. You could include a column for patients who had post-
operative complications, and another column for consults, including the name of the requesting physician."

3. Educate your physician on what the surgical package does and doesn't include. Oftentimes, physicians can still bill separately for treating the underlying condition that led to the surgery, notes Bucknam. "They will have to define that underlying disease process they're seeing the patient for," she warns.

4. Try to plug into your hospital's computer system. Seven Hills Surgical Associates in Lynchburg, VA has started tying into the local hospital's system every day for a list of patients that each of its physicians saw there, according to coder Bobbi Bohon. The hospital inputs all electronic health records (EHRs) and progress notes. As a result, "I capture a lot of charges the doctors don't tell me about," Bohon says.

5. Visit the hospital yourself. "I go to the hospitals twice a week and get the hospital papers out of the boxes," says Bohon. For her physicians' hospital cases, "I'm the first one to touch their dictation," says Bohon. "I'll go through it and separate it out to make sure I don't miss anything.