As CMS fee schedules are being revised to favor primary care services, internal medicine physicians, along with their nurse practitioners, physician assistants, and medical assistants, they need to be aware of ways to maximize their income through appropriate billing. Improving an outpatient internal medicine practice’s financial situation is accomplished through professional medical billing and coding, a robust compliance plan to avoid exposure to charges of fraudulent and abusive billing, and utilizing the full array of codes available for billable services.
- Professional Medical Billing and Coding
Evaluation and management (E/M) services make up the bulk of an internist’s charges. A complete understanding of E/M documentation guidelines will ensure that office visits are billed at their appropriate level. Undercoding services are taken just as seriously as overcoding. Physicians and practice managers should take a critical look as well. Both under and overcoding can result in inaccurate reimbursement that can have longterm consequences. Neither is good for an outpatient practice’s fiscal health.
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Overcoding will result in take-backs, penalties, fines, and interest charges from Medicare, other government health plans, and from commercial insurers. Overcoding is detected during post-payment audits, including RAC audits.
Undercoding is also identified by an audit. However, in the case of undercoded claims, insurers do not owe physicians any penalties, fines or interest charges. They pay for the bills submitted. Undercoding represents lost legitimate revenue for internal medicine practices that do not utilize professionals to handle essential back office billing procedures.
- A Robust Compliance Plan
Being aware of lost revenue or improper coding is the goal of an ongoing compliance plan that is composed of continuing education, continual quality improvement, and adherence to industry best practices. Every member of the healthcare team is responsible for billing compliance, from the patient to the receptionist to the nurse to the physician to the billing office. The chain of events that make up a patient encounter, from scheduled appointments to writing off the last contractual adjustment on a balance, requires a thorough understanding of HIPPA, CMS regulations, private payer contracts, federal and state laws, and correct coding guidelines published by professional associations.
There are so many aspects to coding and billing outpatient medical claims that compliance has become a specialized field in assisting physicians. Ensuring compliance throughout the billing process is insurance that money will not be lost in the future. Partnering with a professional billing company is one of the easiest ways to guarantee compliance. Professional companies keep abreast of industry changes. With experience over a range of specialties, professional insight into particular practices streamlines documentation, coding, and billing — risk is dramatically reduced.
- Billing For All Services
If a physician performs a service, there is a code used to describe it. More often than not, it is a specific code that is intended for reimbursement. Many physicians are not aware of all the billable services they perform during a routine patient encounter. Professional medical billers know when some services are bundled into the main procedure, but, more importantly, they know when services are appropriately unbundled and billed separately.
An injection is not a routine component of an office visit. Neither is a urinalysis or echocardiogram. Performing minor surgical procedures such as a shave biopsy or a cyst aspiration are not bundled into evaluation and management. Instead of referring patients to a specialist, internists should be performing these services themselves (if they feel comfortable doing so), and should be paid for these services in return. As a professional medical billing company, M-Scribe can assist in identifying possible income streams from services already provided but yet to be billed.