Good News: It’s Reimbursement Time Now
Filed a claim during the legal battle between the American Medical Association (AMA) and UHC? There’s good news for you.
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June 15, 2012
Qualedix, Inc. Partners with the Coding Institute to Bring Enhanced Quality and Education to its Managed Services Solution for ICD-10 Testing
Naples, FL (June 15, 2011) –Qualedix, an advanced healthcare testing organization, today announced it has partnered with the Coding Institute, LLC, a company dedicated to offering accurate healthcare solutions, that will provide native ICD-10 coding expertise and educational services to the industry leading Simplicedi testing platform.
The combined market offerings enable greater accuracy, speed and a true clinical approach to tackling the arduous task of testing thousands of new ICD-10 codes for providers and payers alike.
“At Qualedix, we strive for excellence in our data solutions for the industry and clinical knowledge is paramount to effectively remediate and test ICD-10 changes across the healthcare industry. The Coding Institute brings to a new echelon of quality and expert knowledge to better effectively serve the market through our testing managed services,” said Mark Lott, CEO of Qualedix. “Also, all of our clients need education to assist in the transition period and we are proud to have TCI as our education and training partner.”
“The Coding Institute is excited about the opportunity to partner with Qualedix to provide unmatched testing and training to help healthcare professionals implement ICD-10 compliantly and efficiently,” said Jennifer Godreau, BA, CPC, CPMA, CPEDC, Director of the SuperCoder.com and Consulting & Revenue Cycle Solutions divisions of the Coding Institute. “As the healthcare industry’s most advanced ICD-10 testing and education methodology, this managed services solution identifies key areas of focus for hospitals, insurers, and providers and allows us to prevent incorrect coding and revenue losses.”
About Qualedix
Qualedix is a professional healthcare IT quality assurance and software testing firm delivering outsourced managed testing services that leverage our expertise in healthcare and software development lifecycles. Qualedix has developed highly strategic methodologies and techniques designed to deliver critical, cost-effective solutions for 5010 and ICD-10 with highly technical testing experts, healthcare business acumen,...
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June 22, 2011
Follow 3 Tips to Improve Your A/R Process and Boost Your Collections
Avoid the ‘code it, bill it, and forget it’ mentality — don’t be afraid to follow up on your claims.
The economic downturn coupled with looming healthcare changes means that your practice — and all others — are under more pressure than ever to collect every penny you deserve. You can refine your accounts receivable (A/R) process quickly and easily to bring in the money without a lot of extra effort.
A/R defined: “Accounts receivable (A/R) is the money that is owed to the practice,” explains Elin Baklid-Kunz, MBA, CPC, CCS, a director of physician services in Daytona, Fla., during The Coding Institute’s audioconference “Top A/R Tactics: Fight Back Against Lower Payments and Increased Government Scrutiny.”
Follow these three best practices to set your practice on an improved A/R track and avoid thousands in lost reimbursement.
1. Monitor Each Claim You Send Out
The first step in perfecting your A/R process is to make sure someone in your practice is paying attention to what happens to every claim you submit. Ask questions such as: “did the insurance company even receive the claim?” and “Did the patient pay her copay portion of the bill?” “There are companies out there I call ‘code it, bill it, and forget it companies,’” says coding, billing, and practice management consultant Steven M. Verno, CMBS, CMSCS, CEMCS, CPM-MCS, in The Coding Institute’s audio conference “Reveal and Recover Hidden Money You Didn’t Know You Missed.”
“They code the claim, they bill the claim, and then they forget about it. They leave it out there and don’t do anything to bring the money in. They don’t follow up on the claim.” Following up on your submitted claims early in the game can save you time. First ensure that once your practice submits a claim that it is...
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May 10, 2011
Bone Scans: 3 Tips Help You Code Osteoporosis Screening Successfully
Your practice is going to have more patients coming in for bone density screenings, thanks to new recommendations from the U.S. Preventive Services Task Force (USPSTF) that might lower the age at which family physicians could begin screening some women for osteoporosis. Act now to ensure you’re assigning the correct diagnosis codes and verifying medical necessity.
1. Know Osteoporosis, Osteopenia Differences
Many people think of osteoporosis when they hear the term “bone density screening.” Osteoporosis — which literally means “porous bone” — is a disease characterized by low bone mass and structural deterioration of bone tissue. The changes lead to bone fragility and an increased risk of hip, spine, and wrist fractures. The condition is essentially a bone disease caused by dropping estrogen levels in postmenopausal women.
When your physician diagnoses osteoporosis, you’ll select from code family 733.0x (Osteoporosis). Choose the diagnosis based on the patient’s specific type of osteoporosis (such as postmenopausal, idiopathic, etc.). A less-thought-of diagnosis related to bone density screenings is osteopenia (733.90, Disorder of bone and cartilage, unspecified). Patients with osteopenia have lower than normal bone density.
Although osteopenia can be a risk factor or precursor for osteoporosis, not every patient with osteopenia develops osteoporosis.
Screening: Your physician will most likely order a dual-energy x-ray absorptiometry (DXA), which measures bone density, to diagnose the condition. DXA is the gold standard for measuring bone density, coder Donna Richmond with CodeRyte taught in The Coding Institute’s audioconference “Surefire Bone Density Screening Strategies.” Your code choices include:
- 77080 — Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (e.g., hips, pelvis, spine)
- 77081 — … appendicular skeleton (peripheral) (e.g., radius, wrist, heel)
- 77082 — … vertebral fracture assessment.
2. Check for Documented Necessity
Medicare guidelines dictate that your documentation must include an...
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March 29, 2011
No Correct Coding Initiative Bundle? Find Modifier Details in MPFS.
Question: Sometimes I cannot find my two-code pair in the CCI edits. How do I know which code would be considered a column 1 code and which would be considered a column 2 code, so that I could put my modifier on the correct code?
Answer: If the codes are not listed, the codes are not bundled per the Correct Coding Initiative (CCI). You would not need a CCI modifier, such as 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service), 57 (Decision for surgery), or 59 (Distinct procedural service), to override the edit when appropriate.
A private payer could have a black box edit. You would need to check with a rep for a recommendation.
Watch out: Just because a code does not have a bundle in CCI does not mean a modifier is out of the picture. While you won’t need a CCI modifier to override the edit, you might need apayment modifier.
You can find Medicare’s other allowed modifiers for any given CPT code in the Medicare Physician Fee Schedule (MPFS). Columns Y-AC indicate if modifier 51 (Multiple procedure), 50 (Bilateral procedure), etc. apply.
To determine which code receives modifier 51, you need to know the code’s relative value units, which are also listed in the MPFS. Private payers may not adjust claim items in descending order as Medicare’s Outpatient Code Editor software does. If you append modifier 51 to a higher valued item, the private payer may apply the adjustment based on your coding, costing you payment. You should instead list the items in descending relative value order from highest to lowest. Append modifier 51 to the lower priced procedure as necessary. The insurer will then apply the typical 50 percent,...
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November 23, 2010
Handle Your Hand, Wrist Diagnoses With Care by Pinpointing Anatomic Site
Here’s how to differentiate the tiquetrum from the trapezium. Doctors dealing with hand procedures don’t only treat carpal tunnel syndrome, and it’s up to you to link the correct diagnosis to the upper-extremity repair codes. Use this anatomic dr...
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October 28, 2010
Protect Incident To Pay
Incident-to services are on auditors radar. To prevent paybacks, you’ve got to know when to use incident to – and capture full pay, and when to bill services directly – and lose the standard 15%. Test your incident to savvy with this question: Qu...
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August 12, 2010
Boost Injection Pay — Just Ask, Listen for Missed Items
Uncircled vaccines, administrations could cost your practice 10%.
Think increasing payments in 2010 is a fairy tale? Your magic wand is right at your front desk.
“Check-out coding can have a significant financial impact,” reported Norman “Chip” Harbaugh, MD, in...
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April 28, 2010
Critical Care Coding FAQ: Become a Master of Time
Beware: CPT, CMS differ on ‘family discussion’ parameters. When the physician treats a patient with a critical illness or injury, you need to know when to start and stop the critical care clock in order to avoid miscoding. Check out this FAQ to find out what’s part of critical care, what’s not, and how to correctly [...] Related articles:
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- Critical Care Coding Checklist Certain patient conditions could indicate 99291 service. Given the...
- Bust 4 Myths About Pediatric Critical Care Services MYTHBUSTER: Codes 99291, +99292 apply to infants, young pediatric...
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February 8, 2010
Cataract Surgery Coding Skill Builder
Determine ‘planned or unplanned’ before separately coding vitrectomy. With several possible surgical treatments for cataract procedures, which you probably code more often than any other surgery, there’s a lot of room for error – with over $890 at stake for complex cataract procedures in 2009. Use these tricky scenarios as a guide through some of the most [...] Related articles:
- Ophthalmology Coding: See Your Way to Clear Reimbursement for Eye Exams and Cataract SurgeryChoose the Right E/M or Eye Code to Optimize Reimbursement...
- Cataract Surgery Coding: When Optometrist Provides Postop CareWe’ve got the modifier you need when the ophthalmic surgeon...
- Optometry Coding: Eye Exams, Cataract Surgery and Co-ManagementE/M or Eye Code? Choose Wisely With These Documentation Tips...
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January 19, 2010