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OPTIMIZE YOUR REVENUE: ANSWERS TO YOUR TOUGHEST CODING AND BILLING QUESTIONS By Elizabeth W. Woodcock, MBA, FACMPE, CPC Gaining a handle on unpredictable coding and compliance issues is vital to a healthy bottom line, not to mention both employee and patient satisfaction. Without the right tools and processes in place to manage through these constant changes, a practice’s cash flow, and standing with both patient and employees, can quickly deteriorate. Here is a look at some of the common questions practices face, along with answers that will help keep you on the right side of payer policies and, ultimately, optimize reimbursement. QUESTION: My collection agency recovers only 5% of the accounts I send. This seems low. Should I continue sending accounts to this agency? ANSWER: Collection agencies typically recover 5-10% of medical practice accounts, so your agency may be on the low end of the spectrum. Keep in mind, however, that the rate varies based on when you turn accounts over. You’ll have a better chance of recovering balances due on accounts that are 90 days old than you will on accounts 365 days old, for instance. It’s certainly worth it to try another agency to determine if you can bump up your collections, but don’t stop sending accounts even if the return remains at 5%. Why? Sending accounts to an agency is more than a collection recovery tool – it’s sending a signal to patients that you’re serious about collections. QUESTION: I removed impacted cerumen from a patient’s left and right ear in the office. Should I report the code twice? ANSWER: In many instances you are able to bill for this service as a separate procedure, using CPT® code 69210. The description of the code is: “removal of impacted cerumen (separate procedure), one or both ears.” Because the code description clearly states it is used for bilateral services, you should bill 69210 only once whether you perform the service on the left, right or both ears. No modifier is necessary when you perform the service on both ears. QUESTION: I’m thinking about hiring a nonphysician provider, but I am not sure if I can bill for this person’s services. Any advice? ANSWER: State laws dictate several key issues that may assist you in making decisions about hiring physician assistants (PAs), nurse practitioners (NPs) and other nonphysician providers. The ability to prescribe varies from state to state. State law may also dictate the physician supervision requirements. Check also to determine whether you need to be on-site to supervise, check records only or simply employ a provider who can work independently. Pay close attention to the details: some states even regulate who can order therapy, provide services for hospice patients and so forth. For a summary of PA-specific state laws, see the Web site of the American Academy of Physician Assistants (www.aapa.org/gandp/statelaw.html). For nurse practitioners, search for your state at the Web site of the National Council of State Boards of Nursing (www.ncsbn.org/515.htm). States are loosening restrictions on nonphysician providers, so it pays to keep checking for updates. The issues mentioned thus far are limited to state regulations, and do not relate to rules set forth by insurance companies. Before you hire, check the billing rules for Medicare (e.g., “incident to” for office work) and those of the other insurance companies with which you participate. QUESTION: Preventive services don’t have a diagnosis by their very nature. What ICD-9 code should I use? ANSWER: V70.0 – “routine general medical examination at a health care facility” – is the likely choice. However, review the “V” series, the series used for “preventive” diagnoses, to make sure you are choosing the correct diagnosis code, depending on the circumstances. For instance, V70.5 is described as “health examination of defined subpopulations” and includes encounters like pre-employment screenings. Elizabeth Woodcock is the founder and principal of Woodcock & Associates, with 15 years experience in medical group operations and revenue cycle management. A speaker, trainer and author, Ms. Woodcock has led educational sessions for the Medical Group Management Association, the American College of Obstetricians & Gynecologists and the American Medical Association, and has consulted for clients as diverse as a solo orthopedic surgeon in rural Georgia to The Mayo Clinic. She is author of Mastering Patient Flow to Increase Efficiency and Earnings, and co-author of The Physician Billing Process: Avoiding Potholes in the Road to Getting Paid and Operating Policies and Procedures Manual for Medical Practices.
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