Getting reimbursement through Medicare Advantage, and for work with patients with related insurance providers, can be tricky. There are many steps, codes, and areas that can trip you up when you attempt to seek reimbursement. You may already realize that these health plans are reimbursed on the basis of the patients’ chronic conditions. If you make mistakes during diagnosis, or submit a diagnosis with errors, you run the risk of not being in compliance. This will also happen if you deliver a diagnosis which results in a new hierarchical condition category (HCC). Any compliance risk is also a risk that you won’t be paid for your work.
Have You Made Any of These Mistakes?
However, you can take steps to ensure that you get the appropriate HCC codes. One of the first ways to protect your practice is to watch for these common coding mistakes:
- Legible signatures and signatures with credentials were not entered on the record.
- EHRs (electronic health records) were not authenticated. Double-check for an electronic signature.
- The most appropriate ICD-9-CM code wasn’t used with the narrative description of the diagnosis or symptoms within the medical chart.
- The diagnosis codes turned in for billing did not match the description written into the record. Even minor differences, such as the difference between 311 Depressive Disorder and 296.20 Major Depressive Affective Disorder, can nullify your billing.
- No evidence of monitoring, evaluation, assessment/address, and treatment was included in the documentation.
- Chronic medical conditions were not recorded as chronic.
- Records did not include the highest level of specificity regarding symptoms and conditions.
- Annual records were not kept for chronic conditions.
- There was a failure to report the necessary manifestation code.
- Old codes were used rather than current codes.
Clearly, clinical content, adherence to current coding and billing requirements, and demonstrating that regulatory guidelines are constantly followed are necessary in order to consistently obtain reimbursement for services.
Stop Paying for Mistakes
One powerful way to overcome these challenges and avoid most mistakes is to work with a company that will match you with certified coders. These professionals are able to focus on coding, billing, focusing on current compliance rules, and other related tasks. This frees you up to provide the care for your patients that first inspired you to join this profession.
Do You Need Help?
As you evaluate the well-being of your practice, ask yourself the following questions:
- Are records often denied for reimbursement?
- Are you ever at risk of being out of compliance?
- Do you spend excessive time on the phone trying to resolve coding problems?
- Is it difficult to get treatment plans authorized?
- Do you need a solution to recurring coding problems?
If any of these questions prompt a “yes” answer, then call HCC Coders for more information and for answers to your most pressing billing code problems.