Tips to Avoid Poor Medical Coding Practices

The article focuses on certain important areas in the medical coding process where medical coders tend to err in spite of being focused on the job.

Accuracy is important in medical coding because physician reimbursement, medical data collection, hospital payments and physician services all depend on the medical codes. However, errors can occur any time – even when the coders are focused on their work, which is usually a result of the mechanical, routine nature of the work. To avoid poor coding habits, there are a few areas coders need to identify and improve. Accurate medical coding can benefit a medical practice in many ways such as improved patient care, on-time reimbursement, reduced hassle of audits and greater efficiency.

Let us look at some of the key areas where medical coding errors are bound to happen. 

Improper documentation - Often, documentation by physicians is inadequate or incorrect, and then it will be extremely difficult for coders to ensure accurate coding. Coders have a habit of not going too much into the details of medical records. They simply browse or speed read the documents and code accordingly.

For instance, the main code for pneumonia, SARS associated corona virus is 480.31. But, the coder in real terms may mistake it as viral pneumonia and enter the code 480 for the same, resulting in serious error. Coders should be clear and informed about each and every aspect of the codes entered for any health problem.

In certain cases, coders with an objective to increase their productivity do not give adequate attention to the quality side. Consequently, they may use unofficial resources and spend less time reviewing all documentation. They may solely depend on physician dictation and may ignore the associated notes. This can cause a coder to rush through the codes before systematically reading the documents, thus leading to coding errors.  Hence, verifying the medical records and coding system in detail before assigning any specific code is mandatory to avoid the possibility of errors.

Memorizing codes - Experienced coders may happen to memorize several important codes after using them repeatedly. They may enter the codes out of their memory and not refer to any other resources such as medical reference books or journals. At times, their memory power may fail, resulting in coding mistakes. 
Creating cheat sheets - Coding cheat sheet is a limited list of ICD-9 codes and their descriptions. This is a good alternative for coders to keep away from researching codes. However, these resources are not constantly updated (with specific details associated with each code) and can become outdated or are not all precise or detailed enough for accurate diagnosis, leading to potential errors.

Incorrect principal diagnosis selection – Lack of comprehensive knowledge about basic coding principles and terminology results in errors. The coding job experience and the in-depth training undergone by coders will determine their job expertise and also help them stay updated about current coding guidelines. Errors may also occur when coders misinterpret a coding guideline. Incorrect principal diagnosis selection includes – 

  • Applying the coding guidelines wrongly for principal diagnosis (when the coder selects the diagnoses when more than two diagnoses similarly meet the definition of principal diagnosis
  • Coding a specific symptom or sign rather than the definitive diagnosis
  • Coding a symptom when a complication code needs to be assigned
  • Coding from a discharge summary alone

Using clinical encoders – Coders use clinical software programs to follow coding pathways to find out or research on specific codes and DRG (diagnosis-related groups) assignments. Even though software applications may allow them to find codes easily, programs can be defective. Coders may follow incorrect coding pathway, resulting in incorrect code assignment without even the coder realizing that a specific error has happened. Hence, it is highly recommended that coders find codes through the code books even though it is a time consuming process. The end result of inaccurate coding depends mainly on how the codes are used. Instead of relying on any unauthorized websites for the latest medical codes, it is advisable to search for up-to-date codes at the CMS website.

Proficient and experienced medical coders are the hallmark feature of a reliable medical coding company. This is why physicians who choose to have their medical billing and coding done professionally, benefit from the best coding practices and accurate reimbursement. 

Why Should Plastic Surgeons Push Content and Be Active on Social Media?

With its increased usage, social media has become a powerful and dynamic marketing tool in the 21st century, and should be included in every plastic surgeon’s arsenal of marketing methods.

The obvious answer is because your patients are there. A large majority of potential patients are active on social media sites. Now patients are increasingly using the internet to find the right procedure and to look for second opinions from peers and friends in choosing a cosmetic surgeon or an accredited practice and they make decisions based on what they read online. The changing marketing landscape is bound to affect cosmetic surgery practices as much as it affects other businesses and professional establishments. Cosmetic surgery practices simply cannot afford to ignore their growing importance.

Advantages of Active Social Media Participation for Cosmetic Surgeons

Cosmetic Surgery and Social Media

Physicians who fail to use social media in their practices run the risk of falling behind patients’ growing demands for digital communication and allowing negative reviews to define their reputation, say a new research paper by HP Social Media Solutions, a digital consulting firm.
By investing time and resources in creating an active social presence, cosmetic surgery practices can:
  • Reach out to a greater number of potential patients
  • Establish their credibility within their area of expertise
  • Enhance personal image
  • Achieve faster results at less cost
Half of U.S. Plastic Surgeons Use Social Media – Reports ASPS

According to a survey by the American Society of Plastic Surgeons (ASPS), half of U.S plastic surgeons use Facebook, Twitter and other social media platforms to connect with patients. The researchers sent an anonymous survey to more than 5,000 ASPS Member Surgeons. Highlights include:

  • When asked the reasons for using these tools, most surgeons responded that incorporating social media into their medical practices was inevitable. About half said that social media was an effective marketing tool and a useful forum for patient education.
  • One-third of responding surgeons were convinced that social media positively impacted their practice.
  • Roughly half believed that engaging in social media led to increased patient referrals and positive feedback.

Facebook was considered as their primary social media tool followed by LinkedIn, Twitter, and YouTube.

Highlights of Sources & Interactions Study

  • 48% of doctors say they currently use a professional social network (Medscape Physician Connect, QuantiaMD, and Sermo).
  • 39% of physicians in this study use medical association/society social networks for professional purposes.
  • 30% (one-third) of physicians in this study use consumer social networks (e.g., Facebook, LinkedIn, and Twitter) for professional purposes

All these findings show that social media marketing should be included in every plastic surgeon’s arsenal of marketing methods.

Social Media Tips for Connecting Potential Patients to Your Practice

Social media can make you a better plastic surgeon. Here are certain tips to follow:

  • Understand your target audience and what sort of content material they wish to see.
  • Build up awareness of your practice website.
  • Post informative blogs. Users always rely on trustworthy information especially with their concerned procedures.
  • Each social network site has its own variations and discovering the thing that makes them distinct can help you use each one correctly.
  • Keep your patients informed of the latest innovations in the plastic surgery industry.

Top 5 Medical Billing Challenges Impacting Doctors in 2014

Healthcare practices need to streamline their medical billing tasks in order to enhance revenue collection. Medical documentation was much simpler a decade and a half ago. 2014 is predicted to be a challenging year with more medical billing and reimbursement challenges. Physicians should be prepared for the impending changes to the current billing practices.

The biggest challenges of 2014 are the transition from reimbursement based on volume to reimbursement based on value that many providers are experiencing.

HealthLeaders Media survey titled Industry Survey 2014 stated that a full 91 percent of respondents identified low reimbursement rates as an immediate threat to their organization's revenue.

Additional regulations and declining reimbursement make it necessary for physicians to stay updated with the changes in medical billing practices.

What Doctors Should Know?

Let us take a look at the top five medical billing challenges physicians should be aware of.

ICD 10 transition: The long-anticipated, new International Classification of Diseases code set will finally take effect on October 1, 2014. Most other nations have already adopted ICD-10, if only for record-keeping purposes. ICD-9 codes will get replaced with new billing systems using ICD-10 codes.

This new code set replaces the outdated terminology and requires more specific documentation as well as more details about the service that was provided. Real-time documentation with ICD-10 is expected to increase the quality of care. Use of ICD-10 codes requires medical billing and coding personnel to have extensive knowledge of medical terminology as well as anatomy and physiology than was required under ICD-9. Even more time for administrative paperwork will be required by doctors doing the billing tasks themselves.

Health Insurance Exchanges (HIX): With focus on all Americans having access to affordable health insurance options, the Obamacare Health Insurance Exchange that opened on Oct 1, 2013 provides an online marketplace for health insurance. The Health Insurance Exchange implements State specific marketplaces for health insurance. However, HIXs payment rates for doctors remain an uncertainty though some states are already aligning with Medicaid prices, resulting in lower reimbursement rates for doctors.

The latest report is that average premiums offered on the new individual government healthcare exchanges are comparable to and sometimes less than their employer-sponsored counterparts.

Implementing the latest technologies such as EHRs (electronic health records) and comprehensive practice management solutions can streamline physician’s workflow and help handle the patient flow faster, a quality that will be vital when your patient base increases.

Quality reporting: The Centers for Medicare and Medicaid Services (CMS) has developed several quality initiatives that provide information on the quality of care across hospitals, skilled nursing facilities, home health agencies, and dialysis facilities for end-stage renal disease. Non-compliance with these measures will result in penalty.

Physicians who do not participate in Physician Quality Reporting System (PQRS) in 2014 will incur a 2 percent penalty in 2016.

Billing staff members must comply with the quality reporting measures to avoid penalties in 2015 and 2016. In 2015, Eligible Professionals who do not successfully report quality data during the designated quality reporting period will be subject to a Medicare fee-for-service payment reduction of 1.5% that would rise to 2% in 2016 and each subsequent year.

Revised CMS 1500 form: The Centers for Medicare and Medicaid has released a revised 1500 form that is available for use beginning Jan. 6, 2014, to submit claims for reimbursement of services. Use of the revised form is optional until March 31, 2014 and will become mandatory by April 1, 2014. The new form has been designed to accommodate ICD-10 codes and allows expansion of additional diagnostic codes from four to twelve. It is crucial for healthcare providers to ensure that their claims are filed on the appropriate claim forms.

CPT coding changes: 2014 will be seeing the largest CPT code modification in a long time. The American Medical Association (AMA) announced 175 new and 107 revised CPT® codes for 2014, with 25 percent of the changes falling on a single specialty—gastroenterology. A total of 47 codes have been deleted. Keeping up to date with the new codes is crucial to obtaining proper reimbursement for provided services. 

Can You Handle Current Billing Tasks Yourself?

Busy physician practices could consider partnering with reliable medical billing and coding companies to handle these challenging and crucial tasks effectively. The complex medical billing processes require the specialized skill of billing and coding professionals who are AAPC certified. A professional medical billing company:
  • Stays up to date with the changes in healthcare regulations
  • Ensures accurate coding compliant with the latest federal regulations
  • Effectively follows up unpaid and delayed claims
  • Helps smooth transition to ICD-10
  • Provides assistance with obtaining high rates of reimbursement.

How Google’s Hummingbird Changes Can Affect Physician Websites

Google implements dozens of updates every year, with some of them major updates, and others small, but still affecting the rankings of millions of websites on the Internet. The latest one is Hummingbird. While Google’s Panda Update emphasizes the value of informative content and Penguin 2.0 sheds light on how inorganic incoming links can ruin a website’s reputation, Hummingbird offers more relevant answers to search queries. It offers better search experience by utilizing:
  • Google’s Knowledge Graph
  • Conversational or voice search
  • Google Now in Android-powered mobile devices
The algorithm is based on semantic search and focuses on user intent rather than individual search terms. Hummingbird focuses on the meaning behind the words searched for.

Medical Websites and Hummingbird

Healthcare providers, especially specialists like plastic surgeons and cosmetic surgeons, need high SERPs to get the attention of their targeted audience? How does the Hummingbird algorithmic update affect these professionals?

Suppose a person types “Experienced plastic surgeon in NYC” into the search bar. Hummingbird determines the intent of the search and attempts to provide the most relevant and high-quality content based on more than just matching phrases.

Conversational Search

With more and more users performing voice search, short keyword searches are becoming less common. Conversational or voice search involves asking Google a question rather than typing keywords into the search box.

If a person is on the phone and says “Find me an experienced breast augmentation surgeon near where I live?” Google will then parse out what’s ‘experienced’ in this context, where your location is, and so on. Hummingbird better understands the actual location of your home, if you’ve shared that with Google. It understands that “breast augmentation” is a plastic surgery procedure and provides more focused and localized results.

So Hummingbird pays more attention to each word in a query, so that the whole query — the whole sentence or conversation or meaning — is considered, rather than particular words.

Physicians Need to Focus on Quality Content and Long Term Keywords

Hummingbird has a bigger effect on long tail search terms and not on head terms. SEO experts point out that Google is keen to reduce the importance of keywords; its preoccupation is with the quality of the content on the web. So the focus of medical SEO should be creating quality content with relevant long-tail keywords that users will want to read and share.

Plastic surgeons should know that their web pages and content will not be found if they do not provide the answers to specific search queries. For instance, if a potential patient searches “Why should I get a facelift procedure?”, the content that needs to be found in top search results should include the benefits that the procedure would provide and not just promotional stuff. Hummingbird is designed to pick the best search result based on the quality of long tail content.

Staying up-to-date with such algorithmic changes can be quite challenging for busy cosmetic surgeons and other specialists. Medical websites can leverage Hummingbird to improve their search ranking with professional SEO services.

Medical Billing Services for Radiation Oncology

As the main treatment mode for cancer, radiation oncology is used by itself or along with surgery and medication. The demand for these services has been rising in recent years. However, radiation oncology practices are often faced with constant coding changes, reimbursement reductions, and more rigid compliance standards. All these work to considerably reduce practice revenue. Effective medical billing and coding practices are necessary to improve the revenues of these specialized facilities. Professional medical billing services for radiation oncology can ensure proper and timely claim submission for an improved bottom line.

Medical Billing Services Provided for Radiation Oncology

A reliable HIPAA compliant medical billing company can provide medical insurance billing services for individual physicians, physician groups, clinics, hospitals, multi-specialty groups, free standing diagnostic facilities, acute care facilities, and more. Medical billing services offered would include
  •   Patient registering
  •   Charge entry
  •   Claim generation and transmission
  •   Payment posting
  •   Make appeals for denials and incorrect claims
  •   Collection management and more

Availing of these services would ensure peace of mind for the radiation oncology practitioner. A reliable service provider can improve the revenue management cycle of the practice by submitting claims in accordance with the latest practices and speeding up cash flow.

Benefits Gained with Professional Medical Billing Services

  • Fast and reliable service: A reliable medical billing company with a proven track record can offer fast and reliable medical billing for radiation oncology. They can ensure efficient claim submissions to make the reimbursement process from the insurance companies work smoothly.

  • Efficient medical billing system: The billing company would have a medical billing system that supports accurate claim submission. The system would support on-demand invoicing, batch claims processing and interactive electronic claims submission and remission. This allows submission of claims with 99 percent precision, thereby minimizing denials. Electronic claim processing and real-time verification of benefit eligibility would result in better management of revenues.

  • High-end technologies and expert staff: A professional service provider uses state-of-the-art technology and latest infrastructure for medical billing process for radiation oncology. These firms have experienced and skilled medical billers with in-depth knowledge of all the process associated with radiation oncology medical billing. These professionals can process the insurance claims of all major insurance companies including Medicare and Medicaid.

  • HIPAA compliant medical billing practices: Professional service providers adhere to HIPAA guidelines and ensure the safety of all medical billing documents. All file transfer is accomplished using safe, encrypted modes over the Internet.

Find the Right Service Provider

By benchmarking billing adjustments, collections, denials, bad debt, coding accuracy, productivity and profitability and using these to assess practice performance, a professional service provider helps identify the areas that need improvement. It then implements the measures necessary to correct problems and provides efficient and affordable radiation oncology medical billing services to enhance the revenues of the oncology practice. To enjoy all these advantages, you need to team up with a reliable firm. The right service provider can help you save 30 to 40 percent on your operational costs.

Healthcare Exchanges – Where Cancelled Policy Holders Can Find Quality Health Coverage

Florida Blue, a pioneer in offering health insurance plans is canceling 80 percent of its current individual policies. They are dropping around 300,000 customers, because their policies are not satisfying the requirements of the Affordable Care Act. This act was signed into law by President Barack Obama in 2010, with the goal to give more Americans access to affordable health insurance, and thus control healthcare spending in the U.S.

Around 10 topics are addressed by the Affordable Care Act, and each topic (each title) contains sections of provisions that reform the American healthcare system. The titles are given below:
  • Quality, Affordable Health Care for All Americans
  • The Role of Public Programs
  • Improving the Quality and Efficiency of Health Care
  • Prevention of Chronic Disease and Improving Public Health
  • Health Care Workforce
  • Transparency and Program Integrity
  • Improving Access to Innovative Medical Therapies
  • Community Living Assistance Services and Supports Act (CLASS Act)
  • Revenue Provisions
  • Reauthorization of the Indian Health Care Improvement Act55    
According to the act, policies sold in the individual market should cover benefits such as doctor visits, emergency and hospital services, maternity and newborn care, mental health and substance abuse treatment, prescription drugs; rehabilitation and devices that the therapy requires for prevention, chronic disease management, laboratory work, and pediatric services. Moreover, insurers cannot reject people who are sick and can’t charge them with higher prices.

What Holders of Cancelled Policies Can Do

Florida Blue is of the opinion that the affected policyholders can upgrade to a plan that offers more comprehensive benefits. Otherwise they can look for another suitable health insurance plan from the healthcare exchange. Healthcare exchange is a new way to find quality health coverage. It can help
  • Those who don’t have a policy coverage
  • Those who already have a policy, but would like to look at better options
Anyway, the cancellation phenomenon is hitting individual policyholders, and those who had minimal coverage are angry with being forced to buy new plans, as it offers more coverage than what they actually require.

Different Plans Available in Healthcare Exchanges

Healthcare exchange allows customers to select the most appropriate policy of their choice. There are 5 categories of health insurance plans in the marketplace, based on how you can plan and expect to share the costs of care.

  • Bronze: Plan pays 60%. Customer pays 40%.
  • Silver: Plan pays 70%. Customer pays 30%.
  • Gold: Plan pays 80%. Customer pays 20%.
  • Platinum: Plan pays 90%. Customer pays 10%.
  • Catastrophic: Is the coverage option for those under 30 or if they have very low income.
When shopping for a health insurance plan, it's important to understand each plan clearly. Customers should be aware of aspects such as deductibles, premiums, insurer network, HMOs, PPOs, HSAs, and other technical health insurance terms to better understand how its works.

Top Things to Know about Choosing a Plan

Here are 6 things to consider before choosing a health insurance plan:

  • The category of plan you choose affects how much your premium will be and what portion of the bill you pay for things such as prescription medications and hospital visits. It will also have an impact on your overall out-of-pocket costs.
  • All categories of plans offer the same set of 10 essential health benefits. The categories do not reflect the quality of care the plans provide.
  • Keep this general rule of thumb in mind, when selecting a health insurance plan.
    • The lower the premium: The higher the out-of-pocket costs
    • The higher the premium: The lower the out-of-pocket costs
  • Consider the health care needs of your household when selecting the marketplace insurance plan. Do you expect a lot of doctor visits or need regular prescriptions?
    • If you do: better select Gold or Platinum plan.
    • If you don’t: select Bronze or Silver plan
    Bronze and Silver plans are suitable in cases, such as when you have met with a serious accident or have an unexpected health problem, as these plans pay more of the costs.
  • If you can’t afford health insurance, you may be able to get lower costs on your monthly premium. You may qualify for lower out-of-pocket costs for co-payments, coinsurance, and deductibles.

Other options such as Medicaid and the Children’s Health Insurance Program (CHIP) are available. But to avail the benefits of healthcare plans, medical claims need to be submitted without errors and within the prescribed time-frame. Inaccuracies in medical bills and claims can lead to rejection of claims. Due to their hectic work schedule, medical professionals or supporting staff may not be able to concentrate well on medical billing and coding. It is always better for them to associate with a medical billing and coding company that offers professional services with reasonable charges and within the required time limits.

Appointment Scheduling for Patients

Medical practices and facilities have numerous things to do on a daily basis. At the same time, patient appointments have to be managed efficiently to ensure patient satisfaction and timely care. To meet all the requirements in an opportune and systematic manner, healthcare entities need round-the-clock support and a team that is dynamic enough to work on the important appointment scheduling tasks. This is where a medical billing company providing this service becomes highly relevant.

Web-based appointment scheduling is handled with the help of efficient software, which makes the entire process speedy and efficient. It is far more effective than the manual system of scheduling patient appointments. A reliable medical billing firm offers 24/7 support, successfully generating the scheduled revenue for your practice while also ensuring that you receive more time to spend on patient care and related activities.

How a Reliable Medical Billing Company Can Help

Your chosen medical billing company will analyze your appointments and classify them into one-time or recurring schedules. They will answer your calls and take care of the patient appointment scheduling in a thoroughly professional manner. You will find that all important information such as the patient’s name, reason for appointment and other details are incorporated accurately. You can view daily, weekly or monthly schedules.

The Benefits of Online Patient Scheduling System

What are the benefits of web-based patient scheduling system? Here is an overview.
  • The appointments can be organized in a disciplined manner.
  • Allows the bookings of regular patients conveniently as the information becomes available readily.
  • Patient bookings can be cancelled easily and tracked to allow other patients to avail of the services.
  • The personal details of the patients can be stored in the system and used for further reference or subsequent bookings. Moreover, the information can be updated with ease.
  • Easier in providing direction to the patients about the changes in schedule and reminding them about their time of appointment. Moreover, rescheduling the appointments of patients, which is an overwhelming task, becomes very easy to handle.
  • Provides all information regarding the schedule of patients.

Managing the Appointments of Patients

It is clear that appointment scheduling service providers assist a lot in managing the appointments of your patients. Whether in a hospital, physician practice, or other healthcare facilities, the relief is not only experienced by the employees or staff, but also the patients. Apart from ensuring patient satisfaction, the services of a professional medical billing company are distinguished by features such as:
  • Cost savings in the range of 30 – 40%
  • Increased number of patient referrals
  • Streamlined office activities
Sign up for the services of a reliable medical billing company and enjoy practice specific services with a notable increase in revenue.