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Six strategies for improving coding and reimbursement

February 23, 2016

coding_reimbursment.jpgMaximizing a practice’s revenues depends heavily on filing accurate claims that meet all reporting guidelines as well as tracking denials and filing appeals in a timely manner, according to the Medical Group Management Association (MGMA).  Some problems with reimbursement can be traced simply to the need for better organization and assignment of duties within the back office, while other issues such as those pertaining to insurance coverage need to be handled by your front desk. Below are six ways to improve coding and compliance that will increase revenue:

Designate an in-house claims tracker

If the size of your staff permits, assign one person to be responsible for identifying and flagging claims that are reaching the deadline for resubmission or appeal of denied claims – and that any additional required documentation is updated and ready to send as well. Part of this job should include keeping an eye on resubmitted claims to ensure that the payer did indeed receive any resubmission in a timely manner, as well as follow their progress through to receipt of reimbursement.

View denials as a learning experience

One of the most important things staff can do to prevent future denials is to take time to evaluate denied claims, especially if, as recommended by the MGMA, your rate of denials exceeds 5 percent. While software is available for identifying and catching mistakes before they are submitted, in its absence, your staff may need to pay closer attention to the following common reasons for denials:

  • Missing pre-authorization documentation or missing a signed Advanced Beneficiary Notice of Non-coverage.
  • Whether the patient was ‘new’ or ‘established’ as many E & M codes are based on this distinction.
  • Missed deadlines – providers have their own deadlines, so pay attention to these.
  • Conflicts over which payer is primary and which is secondary – your front desk should be verifying correct insurance coverage with each patient encounter.
  • Benefits are denied due not being a covered item. Again, this can be easily remedied by checking benefits before undertaking a specific plan of treatment.
  • Are there any payers who tend to deny more often? If so, these are the ones you want to be sure to send clean claims to the first time out.

Bring physicians and others on board with coding

Having a coder accompany providers to write down information and compare notes later with the provider may reveal that physicians and others omit critical information in notes, such as reading x-rays or reviewing lab reports – if it isn’t noted, it will be undercoded, costing the practice money. Spending a few minutes at monthly staff meetings going over notes with coders can also help providers with accuracy in documenting for improved coding.

Keep current on coding regulations and resources

In addition to CMS requirements to be compliant with implementing the new ICD-10 codes, the AMA annually revises its CPT books for additions, deleted codes and revised guidelines.  Your practice should be using the latest resources to ensure compliance and correct reporting.

Read provider or clinician notes fully before coding

Coders need to take the time to read through a provider’s notes to verify that no necessary information is omitted, especially if just reading through the headers and not the body of the note. For example, the body may hold more diagnostic information that would enhance selecting the most precise code.

Partner with an experienced medical claims services company

As a leader in the medical administration services industry since 2003, M-Scribe Technologies, LLC, has helped thousands of practices of all specialties and sizes with coding, billing and documenting claims.  Contact the M-Scribe team today for a free analysis of your practice’s needs and learn where and how to save money while improving compliance.


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