Practice Management Alert

You may also want to explain any benefits of the method, such as a faster recuperation rate or less physical therapy.

Rabinowitz says her practice usually receives 80 to 100 percent of the reimbursement requested.

For such a plan to work, however, your physicians need to provide accurate and detailed documentation.

When submitting a paper claim with an explanation letter and the operative note, you should write in red ink the patient's policy number on the top right-hand corner of each page. "You'd be amazed at how often things that are attached can become detached," Rabinowitz observes. Putting the policy number on every page in red helps it stand out and makes it easier for claims examiners to determine which pages go together, she adds.

For Medicare claims with unlisted-procedure codes, you may be able to fax the documentation and seven days later file electronically, with a note that documentation was already sent. Rabinowitz says this system cut her reimbursement time from 60 to 90 days to "a fraction of that." However, not all Medicare carriers accept this method. You should ask your carrier for its preferences.

For insurers that prefer paper claims, set up your computer-billing system to suppress electronic submission of unlisted- and new procedure codes, and force the claims to be printed on paper.

Although using an existing code for a similar procedure rather than reporting an unlisted-procedure code may seem easier, this contradicts CPT's directive and prevents new codes from being established. "It's only when an unlisted code is used frequently enough for a procedure that it gets a temporary code, and eventually a permanent code," Rabinowitz says. In addition, reporting an alternative code does not adequately reimburse your physician for the work he or she performed. Each code is assigned reimbursement that reflects the amount of work involved. Substituting a code misrepresents your physician's work and will probably result in less revenue.

Before your physicians commit to using new products or devices, make sure there is the possibility that you can get reimbursed for them, advises Debbie Pacyna, CPC, administrator of the three-physician practice Urologic Health Center of New Jersey in Toms River. Before medical product manufacturers begin marketing their products to doctors, they usually research how providers can get paid for them. You should contact the manufacturer for an explanation of the product, its medical benefits, and how it will be reimbursed.

"I always ask the manufacturer's representative what the billable codes are for the procedure and items, whether Medicare and our other payers will recognize those codes, and how much reimbursement we can expect. If they can't provide me with that information, I have to say to my doctors, 'You may want to do this new procedure with this new product, but I'm not sure you're going to get paid,'" she says. When the manufacturer is uncertain of how to bill the new procedure or device, Pacyna says that's a signal to her that the practice should consider waiting before starting to use the new procedure or device because it's just too new, and reimbursement too uncertain.

Remember, however, that manufacturers are not coders. You should always look up any manufacturer-suggested codes in the ICD-9 and CPT reference books to see if they are appropriate. $ $ $