AAPC-Certified Coders Ensure Payer Compliance.

We have AAPC-Certified Coders to review and audit medical records to ensure payer compliance and that your providers are making the most of patient office visits. This in turn helps you gain the correct revenue per patient while also learning how to improve records management and coding initiatives for the future.

ICD-10 codes are a departure from older diagnostic coding systems. One billing practice that raises red flags for insurers is using the same code repeatedly for multiple patients. The truth is, limiting yourself to a single code presents problems for both insurer and patient. Here’s why:

– You might be accustomed to relying on “pain codes.” These are ICD-9 codes that refer to the patients’ actual complaints during consultations. The problem with handling diagnoses in this fashion is that you’re only describing symptoms. Treating symptoms does not necessarily result in increased wellness. ICD-10 codes are meant to encourage and enable best practices for diagnosis and billing. As a result, ICD-10 works best when you choose codes that address the root cause of a patient’s problem.

– New ICD-10 codes are so specific that they need to be used together to paint clear “portraits” of your individual patients. The use of a single code can appear inaccurate simply because it’s monochromatic. If it were a painting, a single code would show Snow White in a snowstorm. When that’s all you submit, insurers worry that you’re not investigating deeply enough when you diagnose a patient or that you’re not understanding the importance of clearly communicating with insurers. Use multiple codes to provide a detailed rendition of your patient’s needs.

– There’s an even bigger issue: Non-specific codes can cause confusion because they don’t seem to justify the services a patient receives. Whether you recommend additional procedures, referrals or prescriptions, if the code you’re using doesn’t reflect your reasoning, you’re setting yourself up for a denial of reimbursement. Underusing ICD-10 codes denies patients services.

It’s best to check your codes multiple times before submitting a claim. Other common errors you should be aware of include:

  • Upcoding: Whether done intentionally or by mistake, upcoding happens when codes are switched out for more expensive medical procedures. This is a very common coding error. It is also illegal. Make sure your practice isn’t adding in or exchanging codes to boost revenues falsely.
  • Undercoding: Unlike upcoding, undercoding happens when a medical practice leaves out or switches codes for less expensive procedures. To keep this from happening, make sure your communication lines are clear and your billing staff is on the right page.

– Another important factor: Keep in mind that individual physicians aren’t islands unto themselves. You are one link in a chain of providers who serve any given patient. The codes you choose will help other healthcare professionals glean insights and draw conclusions about the next steps they should take. There are even “cause codes” that explain how and where an injury occurred. An inaccurate or non-specific code can cause misdiagnosis and implementation of inaccurate therapies. Using the correct codes opens dialogue between the initial physician and specialists.

Streamline Patient Care, Billing & Reimbursement

The goal is not to simply pile on additional codes, but rather to thoroughly document a patient’s condition and improve the dialogue between providers. By understanding how to apply ICD-10 codes in combination with each other and implementing them as they were designed to be used, you will streamline patient care, billing and reimbursement.

ICD-10 contains five times as many codes as ICD-9, and major code additions and revisions are already on the way. At the March meeting of the Coordination and Maintenance Committee, covering everything from ectopic pregnancy to the Zika virus, 1,900 code changes were proposed. That’s on top of nearly 4,000 new codes already set for Fall of 2018.

The increased specificity ICD-10 provides is meant to improve diagnostic coding and streamline payout rates. But it’s a lot to keep track of, and many practices are intimidated by the prospect, even with this year’s specificity grace period.

EMR Software Helps You Navigate the Complexity of ICD-10

It can also ensure your practice is implementing the coding changes smoothly. How can it help?

  1. EMRs conduct automatic updates. If seventh-character code extensions are intimidating your office staff, imagine how nervous they are about new and revised codes. New codes are longer, too, up to seven digits compared to the three- to five-digit ICD-9 codes. But EMRs can help make the process of adopting new codes relatively painless. As changes roll out, cloud-based EMR software can roll with them, providing you with constant code updates so that you can be sure you’ve always got the correct codes.
  2. EMRs provide easy access to prior patient visits. Because you have centralized, digital records, you won’t have to go hunting for codes. You’ll be able to build a complete portrait of a patient’s needs using multiple codes. You can feel secure that none of that information is being lost or forgotten from visit to visit. And you’ll be able to pass it along to specialists, therapists and lab technicians, too.
  3. EMRs make finding the right code easier. As we mentioned earlier, physicians are still operating in what the CMS is calling a “specificity grace period,” which means that as long as the codes you choose are in the right family, you’re unlikely to be penalized if they’re not as specific as they ought to be. That said, the grace period will draw to a close right as the 4,000 codes we mentioned earlier are added. So, how do you ensure that you’re choosing the specific codes you should be? Well-thought-out EMR software is designed to help you search for and narrow down codes, saving you time and effort.
  4. EMRs cannot substitute for medical and billing expertise. It’s important to train your employees on ICD-10 using the many free resources available, and make sure they understand how to use the many tools your medical record and billing software provides. EMRs are a flexible resource that helps savvy practices improve ICD-10 implementation and provides automatic updates.

Count on SAVI to help you get your coding right so you can reduce claims denials and maximize your reimbursements.

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